| Objective : Evaluation of the application of ultrasound-guided Erector Spinae Plane Block(ESPB)and Transverse Abdominis Plane Block(TAPB)in patients undergoing open liver cancer surgery.Methods:Select 60 patients with open partial hepatectomy under general anesthesia,50 males and 10 females,ASA I ～ II grade,age 18 ～ 65 years,BMI18～30kg/m2,Classification of liver function Child-push grade A or B Grade,The patient is willing to take the test,meets the ethical requirements,and signs the informed consent form.Randomly divided into three groups with random number table: Erector spinae plane block group(group E),Transverse abdominis plane block(group T)and control group(group C),each group had 20 cases.Before anesthesia induction in Group E,bilateral ESP block was guided by ultrasound and given 20 ml ropivacaine of 0.4%.In group T,bilateral TAP block was guided by ultrasound and given 20 ml ropivacaine of 0.4% before anesthesia induction.No block in group C.Target-controlled infusion(TCI)of propofol combined with sufentanil under bispectral index(BIS)guidance is used for induction and maintenance,and PCIA for postoperative analgesia.Observing the mean arterial pressure,heart rate in the three groups,and recorded the total amount of sufentanil used during and after the operation,the amount of fluid infusion during the operation,the amount of bleeding during the operation and the operation time were recorded.Follow up and record the visual analogue scores(VAS)of patients at 3,6,8,24 and 48 hours after operation.Record the the number of effective compression of the analgesia pump within 48 hours after operation,and the recovery rate of additional analgesics;record the time of the first out of bed activity after operation,the time of the first exhaust defecation,and the occurrence of adverse reactions such as dizziness,nausea and vomiting,pruritus,and puncture complications.Results:There is no statistical difference in the general data of the three groups of patients;The amount of sufentanil used in group E and group T was significantly reduced compared with group C(P<0.05),and there was no significant difference between group E and group T(P>0.05);There was no significant difference in the total amount of sufentanil postoperatively among the three groups of patients(P>0.05),and the number of compressions of the analgesic pump in group E and group T within 48 h was significantly less than that in group C(P<0.05);The frequency of postoperative rescue analgesia in group E and group T was significantly reduced compared with group C(P<0.05).Compared with group C,the increase of MAP and HP in group E and group T during skin incision T1,peritoneal incision T2 and after opening the abdominal cavity T3 was significantly lower than that in group C(P <0.05);After extubation,3h postoperatively,and 6h postoperatively,the VAS scores in groups E and T were significantly lower than those in group C(P <0.05),and there was no significant difference between groups E and T(P> 0.05);The 12 h postoperative VAS score of group E was significantly lower than that of group T and group C(P<0.05),and there was no significant difference between group T and group C(P>0.05);The number of patients who exhausted and got out of bed within 48 hours after operation in group E and group T was significantly higher than that in group C(P<0.05),and the incidence of dizziness,nausea and vomiting was significantly reduced(P<0.05);At 3 hours after operation,the carbon dioxide accumulation in group E was significantly reduced compared with group C(P<0.05);The increase of lactate levels during surgery T1 in PACU during T2 and in PACU during T2 in group E and T was significantly lower than that in group C(P<0.05),There was no significant difference between group T and group E(P>0.05),there was no significant difference between group T and group E(P>0.05);There were no significant differences in some immune and liver function changes among the three groups(P>0.05).Conclusions:1.Preoperative ultrasound-guided single Erector spinae plane block can significantly reduce the total use of opioids in patients undergoing open hepatectomy,at the same time,it can significantly advance the time of getting out of bed,reduce the incidence of adverse reactions,and improve the effect of postoperative analgesia.2.The perioperative analgesic effects of Erector spinae plane block are better than Transverse abdominal plane block. |
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