Application Of Ropivacaine Combined Usage With Conventional Proposal Of Analgesia After Laparoscopic Surgery For The Treatment Of Extrahepatic Biliary System Calculi

Objective: To evaluate the safety and efficacy of 0.75% ropivacaine local infiltration combined with conventional proposal of analgesia after Laparoscopic surgery for the treatment of extrahepatic biliary system calculi including cholecystolithiasis and choledocholithiasis.Methods: The sample size was calculated by using the calculation formula of the two-sample-average-comparison sample content.A total of 70 patients with cholecysto-choledocholithiasis undergoing elective LC+LCBDE from the department of hepatobiliary and pancreatic surgery in the second people’s Hospital of Chengdu were included in this randomized,double blind,placebo-controlled trial according to the entry and exlusion criteria from June 1th 2016 to December 31 th 2017.The patients were randomly divided into Combined group(35 cases)and conventional group(35 cases)by using SPSS24.0 software,all of them signed informed consent.Both groups underwent the same type of anesthesia and were operated by the stationary surgeon and surgical teams.After intraperitoneal operation is completed,a total of 20 ml injection was sprayed to the intraperitoneal surgery wound and subdiaphragmatic area on both sides;Before closing the abdomen,infiltration with 2ml injection to the 4 port site was performed(Combined group injection: 0.75% ropivacaine;control injection: normal saline.);Both of the postoperative patients were given dezocine 20 mg + tropisetron 4mg diluted with normal saline to 100 ml for continuous intravenous analgesia until 48 hours after operation.Different kinds of data were recorded after the operation,including the NRS pain scores(2h,4h,6h,8h,10 h,12h,24 h,48h),the WBC、PCT value(day 1,day 3,day 5),the time to first getting out of bed,the time to first anal exhaust,the frequency of pressing the analgesic pump and the consumption of postoperative analgesia pump drug,also including cases of rescue analgesics and postoperative shoulder pain,postoperative side effects and complications,duration of postoperative hospital stay and total hospitalization costs.Statistical analysis was performed to compare whether there was statistical significance between the two groups.Results: A total of 70 patients that meets the inclusion and exclusion criteria(35 patients in each group)were recruited in our study.In the Combined group,there was 1 case converted to open surgery due to observation of gallbladder triangle dense adhesions,during the laparoscopic surgery;There were 1 case in the Combined group and 2 case in the conventional group excluded from the study because of use of the intravenous controlled analgesia pump time <48h.In the final 33 cases of the Combined group,33 cases of the conventional group completed the scheduled clinical study.There were no serious complications and death cases during the perioperative period,and no signs of local anesthetic toxicity were observed in the both groups.The patients’ morphometric and demographic characteristics as well as the details of surgery had no significant difference between the two groups(>0.05).The postoperative NRS pain score(2h,4h,6h,8h)in the Combined group was lower than that in the conventional group(P <0.05).The WBC in the Combined group was lower than that in the conventional group on the third day after operation(P <0.05).The time to first getting out of bed in the Combined group was earlier than that in the conventional group(P <0.05),the time to first anal exhaust in the Combined group was earlier than that in the conventional group(P <0.05).The frequency of pressing the analgesic pump in the Combined group was fewer than that in the conventional group,the difference was statistically significant(P <0.05).The drug consumption was less than that in the conventional group,the difference was statistically significant(P <0.05).In the Combined group,the number of required rescue analgesics cases was less than that in the conventional group,which was statistically significant(P <0.05).The number of complained postoperative shoulder pain cases in the Combined group was lower than that in the conventional group,the difference was statistically significant(P <0.05).The Combined group and the conventional group had no significant difference in postoperative dizziness,nausea,vomiting,abdominal distension,urinary retention,lung infection,incision infection and biliary leakage(P> 0.05).The duration of postoperative hospital stay and total hospitalization costs in the Combined group were less than that in the conventional group,the difference was statistically significant(P <0.05).Conclusion:(1)Combined local infiltration analgesia with 0.75% ropivacaine and Patient-controlled intravenous analgesia of dizocine after laparoscopic surgery for the treatment of extrahepatic biliary system calculi is safe and effective.(2)Compared with the single-mode Patient-controlled intravenous analgesia of dizocine,multimodal analgesia with 0.75% ropivacaine local infiltration analgesia and Patient-controlled intravenous analgesia of dizocine can reduce the dose of dezocine,theearly postoperative acute pain and the incidence of shoulder pain,can help the postoperative patients to get out of bed earlier,accerlerate the recovery of gastrointestinal function,enhance recovery after laparoscopic surgery for the treatment of extrahepatic biliary calculi.