Effect Of Transversal Plane Block Combined With Hydromorphone On Analgesic Effect And Stress Response After Gynecological Malignant Tumor Surgery

Objective:To observe the effect of ultrasound-guided Transversus abdominis plane(TAP)block combined with hydromorphone on stress response in patients with laparoscopic gynecological malignancies,and to evaluate its efficacy and safety in postoperative analgesia in patients with laparoscopic gynecological malignancies.Methods : A total of 60 patients undergoing laparoscopic gynecological malignant tumor surgery were selected and randomly divided into T group(experimental group)and C group(control group),with 30 cases in each group.Group T: Bilateral TAP block was performed after surgery.Patients were injected 0.25% ropivacaine 15 m L on each side +Patient-controlled intravenous analgesia(PCIA).Group C: simple postoperative PCIA.PCIA configuration: hydromorphone 40μg/kg,diluted to 100 m L with normal saline,background dose of 2m L/h,3m L added at a time,15 min lock time.Visual analogue scale score(VAS)and Bruggrmann comfort scale score(BCS)during resting and exercise(cough)were recorded at4 h,8h,12 h,24h and 48 h after surgery.The number of effective analgesic pump compressions and the occurrence of adverse reactions within 48 h after surgery;Postoperative recovery indexes were recorded: anal exhaust time,first time to get out of bed,postoperative hospitalization days.Serum Cortisol(COR),Interleukin 6(IL-6),and Tumor necrosis factorα(TNF-α)levels were collected in peripheral venous blood samples before and 24 h after surgery,and compared statistically.Results:1.VAS scores at rest and exercise(cough)at 4h,8h,12 h,24h and 48 h in group T were lower than those in group C(P<0.05).2.The BCS score of T group was higher than that of C group at 4h,8h,12 h and 24 h after surgery(P<0.05),but there was no statistically significant difference between the two groups at 48 h after surgery(P>0.05).3.The number of effective analgesic pump compressions and analgesic relief cases in group T were lower than those in group C 48 hours after surgery(P<0.05);4.The levels of COR,IL-6 and TNF-α in serum of 2 groups after surgery were higher than those before surgery.Compared with group C,the levels of inflammatory factors in serum of group T after surgery were significantly lower than that of group C(P<0.05).5.There was 1 case(3.3%)in group T and 6 cases(20%)in group C.The incidence of Post operative nausea and vomitting(PONV)in group T was significantly lower than that in group C(P<0.05).No drowsiness was observed in group T after surgery,and 1 patient was observed in group C,with no statistical significance between the two groups(P>0.05).6.Compared with group C,the time of anal exhaust,the time of first getting out of bed and the days of postoperative hospitalization in group T were significantly shortened(P<0.05).Conclusion:Ultrasound-guided TAP block combined with hydromorphone PCIA multi-mode analgesia can effectively reduce postoperative pain scores in patients with laparoscopic gynecological malignant tumor,reduce the application of postoperative opiates,reduce stress response,and provide an effective strategy for early postoperative rehabilitation of patients with laparoscopic gynecological malignant tumor.