The Effects Of Different Drug Injecting Sites On The Transverse Abdominis Plane Block Range And The Early Postoperative Recovery In Patients Undergoing Radical Resection Of Colorectal Cancer

Objective:To investigate and compare the block range,postoperative analgesic effect and postoperative analgesia of TAP with different injection sites on the same horizontal line,including anterior axillary line,mid-axillary line,and posterior(lateral edge of transversus abdominis).The incidence of complications(local swelling and injection site-pain and...,etc.).Methods:There are 90 patients undergoing elective laparoscopic radical resection of colorectal cancer,American Society of Anesthesiologists(ASA)grade II,III or IV,aged 50 to 70 years old,ultrasound-guided TAP block.The transverse abdominal muscle plane corresponding to the lowest point of the costal margin on both sides,the intersection point of the axillary front(group Q),the midaxillary line(group Z)and the lateral edge of the transverse abdominis muscle(group H)were selected as the injection points,respectively.Each side is given 0.25% ropivacaine 30 ml.Observe the patient’s body block at 10 min,20min,and 30 min after the completion of the injection.Use 75% alcohol to perform cold-temperature sensation and acupuncture to determine the blocking effect of each area of the patient’s abdomen and back.The positive rate is used to determine the effectiveness of the block in each area.Results:All patients were 50 to 70 years old,and had a body index(BMI)of 20 to 25.There are 105 cases of patients with abdominal transverse plane structure under ultrasonic display not clear ruled out in 5 patients,there are 8 cases of patients with surgical procedure to a laparotomy hence hereby excluded,and 2 patients withdrew from the study.Finally,conform to the requirements of the study of 90 patients were included in this test.Observation of the range of block: the positive rate of zone 1,2,3,5,6,10,13(anterior abdominal wall and lower lateral abdominal wall)in group Q was more than 95% and stable,that is,the range of block was in the anterior abdominal wall and the lateral abdominal wall of the lower part.The positive rate of zone 2,3,5,6,10,12 and 13(anterior abdominal wall and the lower part of lateral abdominal wall)in group Z was greater than 95% and stable,that is,the administration points in group Z had effective and stable blocking effect on the anterior abdominal wall and the lateral abdominal wall of the lower part,and the blocking range was similar to that of the front axillary group,but the blocking range was wider.It also has a blocking effect on the medial front of the thigh.The positive rate of 5,6,9,10,12,13,16,18 and 19 regions(lateral anterior abdominal wall,lateral abdominal wall and back)in group H was more than 95% and stable,that is,compared with the former two groups,group H had the widest range of blockade,which covered the lateral anterior abdominal wall,lateral abdominal wall and back.There was no statistical significance in resting and motor VAS scores at 24 and 48 hours after surgery among the three groups(P > 0.05).The first anal discharge time and the first time of getting out of bed in group H(lateral edge of transverse abstris muscle group)were significantly earlier than those in group Q(anterior axillary line group)and group Z(middle axillary line group)(P < 0.05),and the probability of dizziness,nausea and vomiting in group H was significantly lower than that in groups Q and Z(P < 0.05).There were no significant differences in the incidence of skin itching and pain at the injection site among the three groups(P > 0.05).Conclusions:Under ultrasound-guided TAP block,the block range is different at different administration sites on the same level.The injection point is the intersection of the costal border and the anterior axillary line.The block range is on the anterior abdominal wall and the lower part of the lateral abdominal wall;the injection point is between the costal border and the anterior axillary line.At the intersection of the mid-axillary line,the blocking range is not only the front abdominal wall and the lower abdominal wall,but also has a certain blocking effect on the inner front of the thigh.The injection point is the lateral edge of the transversus abdominis muscle.The block range is the widest.The block range is on the outside of the anterior abdominal wall,the lateral abdominal wall and the back,which is more beneficial for early recovery after radical resection of colorectal cancer.