Application Of Esketamine Combined With TAPB In Rapid Rehabilitation Of Gynecological Laparoscopic Surgery

Objective:To assess the impact of Esketamine combined with abdominal transverse plane block(TAPB)in the expeditious recovery of gynecological laparoscopic surgery patients,evaluate the security of this anesthesia and analgesia technique,and hasten the postoperative rehabilitation of patients.Methods:The experimental subjects were 60 patients who underwent gynecological laparoscopic surgery(LS)in our hospital from March 2022 to January 2023,and were randomly allocated into T group(TAP group)and ET group(Esketamine+TAP group)with 30 patients in each group.In the T group,TAPB analgesia was administered,while in the ET group,Esketamine combined with TAPB was used for multimodal analgesia.Anesthesia and analgesia effects were recorded through intraoperative data of related indexes and repeated visits to patients within 48 h after surgery.Comparison of intraoperative doses of anaesthetic drugs between the two groups,intraoperative hypotension(MAP less than 60 mm Hg),the amount of severe bradycardia(HR below45 times/min);postoperative T0(immediate admission to PACU),T1(at discharge from PACU),T2(4h postoperative),T3(12h postoperative),T4(24h postoperative),T5(48h postoperative)resting and cough visual analogue pain(VAS)scores;and postoperative recovery observation indexes were compared between the two groups,including resuscitation extubation,recovery room stay,first exhalation,first ambulation activity and length of hospital stay.The first time of analgesic pump pressing,Total amount of sufentanil analgesic pump 24 hours after surgery,total white blood cell count(WBC),incidence of adverse reactions and patient satisfaction.All data were processed by SPSS26.0 software.Results:(1)The doses of propofol and remifentanil used for perioperative sedation and analgesia were significantly lower in the ET group compared with the T group(P<0.05);(2)compared with the VAS scores at rest,the VAS scores at all time points in the coughing state were significantly higher in both groups(P<0.05);the VAS scores at all time points in the resting state and coughing state were significantly lower in the ET group compared with the T group(P<0.05);however,the VAS tended to decrease with the extension of time after surgery in both groups,and there was a difference in VAS scores at six time points(P<0.05);(3)In terms of time to extubation,time to recovery room,time to first exhaustion,time to first bed activity,and days of postoperative hospitalization,the recovery time of each index was significantly shorter in the ET group compared with the T group,and there was a statistical difference(P<0.05).(4)The first press of the analgesic pump was longer in the ET group than in the T group(P<0.05);the dose of sufentanil in the analgesic pump was lower in the ET group than in the T group 24 hours after surgery(P<0.05);(5)The WBC after 1 d of surgery in the ET group was lower than that in the T group(P<0.05);(6)The incidence of severe hypotension and bradycardia during anesthesia in the ET group was significantly lower than that in the T group(P<0.05);the incidence of severe hypotension and bradycardia during anesthesia in the ET group was significantly lower than that in the T group(P<0.05).0.05);the incidence of postoperative complications nausea and vomiting,agitation and dizziness were lower in the ET group than in the T group,with statistical differences(P<0.05);(7)the satisfaction score at 48 h postoperatively was(8.17±0.59)higher in the ET group than in the T group(6.97±0.49)(P<0.05).Conclusion:(1)The use of Esketamine combined with TAPB in the rapid recovery of gynecological laparoscopic surgery can reduce the dose of propofol and remifentanil in the perioperative period,resulting in smoother hemodynamics in the perioperative period;(2)Esketamine combined with TAPB can significantly reduce the acute pain of patients up to 48 hours after surgery,prolong the time of the first pressed analgesic pump and reduce the dosage of opioids in the first day after surgery;(3)Esketamine combined with TAPB can shorten the time of extubation,the time of stay in the recovery room,the time of the first bed activity and the time of recovery of gastrointestinal function,which can also shorten the hospital stay and accelerate the postoperative recovery of patients;(4)The combination of Esketamine and TAPB can reduce the total postoperative WBC level and has an anti-inflammatory effect,which can consolidate the surgical effect;(5)The incidence of adverse reactions of Esketamine and TAPB is low,which can obtain high patient satisfaction and is worthy of It is worth promoting the application.