Effect Of Ultrasound-guided TAP Block Combined With Hydromorphone On The Postoperative Analgesia And Inflammatory Response In Colorectal Surgery

Objective To evaluate the postoperative analgesia effect of ultrasound-guided Transverse Abdominal Plane Block（TAPB）combined with hydromorphone patient-controlled intravenous analgesia for postoperative analgesia in patients with colorectal surgery and reduce perioperative pain The effects of opioid dosage,early recovery of patients and inflammatory response of trauma pain,provide a basis for clinical application.Methods A total of 42 patients undergoing elective colorectal surgery in the People’s Hospital of Inner Mongolia Autonomous Region from December 2020 to February 2022 were selected and included.Ultrasound-guided transversus abdominis plane block combined with patient-controlled intravenous analgesia group（T group）of 21 cases.Group T was given bilateral TAPB with 0.25%ropivacaine before induction of general anesthesia,and group C was the control group.Both groups were treated with patient-controlled intravenous analgesia after operation,and the analgesic solution was hydromorphone 50μg·kg^-1·100 m L^-1;the pain and vision of the two groups were compared at 4,8,12,24,and 48 hours after recovery from anesthesia.Analogue score（Visual Analogue Scale,VAS score）,comfort score（Bruggrmann Comfort Scale,BCS score）,the number of patient-controlled analgesia compressions（PCA times）,the occurrence of adverse reactions to anesthesia,anal exhaust time,time to get out of bed and extraction Catheterization time,inflammatory factor levels at18h after operation,including:high-sensitivity C-reactive protein（CRP）,interleukin-6（IL-6）,tumor necrosis factor alpha（TNF-α）.Results The VAS scores of the T group at 4 and 8 h after tracheal intubation were significantly decreased[（0.9±0.8）vs.（1.6±0.9）points at 4 h,and（1.1±0.9）vs.（1.6±0.7）points at 8 h].The scores increased[（2.9±0.6）vs.（2.4±0.7）at 4 h,（2.8±0.6）vs.（2.4±0.6）at 8h],and the intraoperative remifentanil dose decreased[（0.43±0.6）vs.（0.47±0.05）μg·kg^-1·min^-1]（P=0.03）The number of compressions for PCA within 4～8 hours after operation decreased[（0.3±0.6）vs（0.9±0.6）times]（P=0.00）.The incidence of postoperative nausea and vomiting decreased（14.0%vs.28.0%）,and there was no significant difference in the time of anal exhaust,the time to get out of bed for the first time,and the time to remove the catheter（P>0.05）.Serum CRP,IL-6 and TNF-αlevels in group T decreased at 18h after operation[CRP:18h（45.0±7.3）vs.（62.4±6.2）mg/L;IL-6:18h（79.4±2.2）ratio（97.5±5.2）ng/L;TNF-α:18h（40.6±2.5）vs（51.8±2.9）ng/L],the difference was statistically significant（P<0.05）.Conclusion Ultrasound-guided transversus abdominis plane block combined with hydromorphone intravenous patient-controlled analgesia can achieve good analgesic effect in colorectal surgery,can reduce the perioperative opioid dosage,reduce the body’s inflammatory response,and promote patient The rapid recovery has clinical application value.