Clinical Significance Of Ropivacaine Local Infiltration For Postoperative Analgesia After Total Laparoscopic Radical Gastrectomy In Elderly Patients

Objective To investigate the effects of postoperative analgesia using the ropivacaine incision infiltration in the elderly patients after total laparoscopic radical gastrectomy.Methods67 elderly patients who underwent traditional total laparoscopic radical gastrectomy received standard general anesthesia.At the end of surgery,patients were randomly divided into 3 groups:groupⅠ(0.5% ropivacaine incision infiltration,40 m L in total,n=24), groupⅠ(0.9% sodium Chloride Injection incision infiltration,40 m L in total,n=22),and groupⅢ(No analgesics was administered, n=21).The intensity of postoperative pain was evaluated using numeric rating scale(NRS) in a double-blinded manner.Intramuscularly 10 mg of morphine was administered as rescue medication when NRS was above 4.The NRS, number of cases to remedy analgesia and the associated side effects were observed and recorded at 6 h postoperatively. the time of postoperative ambulation,peristalsis recovery,the complications incidence,postoperative hospital stay and medical expenses were compared between the groups.Results There were significant differences among group Ⅰ(2.66±0.26、2.43±0.35、2.28±0.84、2.06±0.91),groupⅡ(5.48±0.13、5.83±0.64、3.97±0.51、3.74±0.72)and groupⅢ(5.62±0.29 、 5.66±0.49 、 3.86±0.60 、 3.72±0.55) in NRS at 6 、 12 、 24 、 48 h postoperatively(P < 0.05). We found that ropivacaine local infiltration was associated with decreased the number and frequency to remedy analgesia. There was no obvious adverse effect about ropivacaine in all groups at 48 h postoperatively. The time of postoperative ambulation and peristalsis recovery were shorter for groupⅠ【(52.84±8.82) hours,(80.03±5.94) hours,respectively 】 than for group Ⅱ【(91.35±10.89) hours,(104.75±9.29) hours,respectively】and groupⅢ【(92.65±11.08) hours,(108.63±10.36) hours,respectively】.Meanwhile, postoperative hospital stay and medical expenses were significantly less in groupⅠ【(10.17±1.28) days,(5.75±0.44) ten thousand yuan,respectively】 than that in groupⅡ【(12.65±1.37) days,(6.27±0.59) ten thousand yuan,respectively】and groupⅢ【(12.94±1.58) days,(6.45±0.68) ten thousand yuan,respectively】. As for complications, the incidence of groupⅠ was 8.33 % and that of groupⅡwas 22.73 %, groupⅢwas 19.05 %, the differences among the groups were significant(p<?0.05).Conclusion The results imply that ropivacaine infiltration may reduce postoperative pain after total laparoscopic radical gastrectomy in the elderly patients,lead to faster recovery and provide an alternative better analgesia.