Effects Of TFP-RSB And TFP On Inflammatory Stress And Postoperative Analgesia In Patients With Gynecological Laparoscopic Hysterectomy And Diabetes

Objective:To compare the analgesic efficacy and inflammatory response of transabdominal fascia block combined with rectus muscle sheath(TFP-RSB)and transabdominal fascia flat block(TFP)in patients with diabetes after total hysterectomy.Methods:Eighty-seven patients with type 2 diabetes mellitus who underwent gynecological laparoscopic hysterectomy in the second Hospital of Shanxi Medical University from December 2021 to September 2022 were randomly divided into three groups: TFP-RSB group(n = 29),TFP group(n = 28)and blank control group(n = 30).The patients in TFP-RSB group were given TFP-RSB block under the guidance of ultrasound.The patients in TFP group were given TFP block with 0.375% ropivacaine.Two groups combined with patient-controlled intravenous analgesia pump(PCIA)compound analgesia.The control group was only connected with PCIA after operation.The analgesic efficacy and postoperative sleep quality were compared among the three groups.IL-6 and Apelin-13 were measured before and at 6h,12 h and 24 h after operation,and blood glucose was measured at 6h,12 h and 24 h after operation.Results:The blood glucose of TFP-RSB group and TFP group were lower than that of the blank control group at 2h,12 h and 24 h after operation(P < 0.05).There was no significant difference in the dosage of propofol and remifentanil among the three groups(P<0.05).The postoperative VAS scores in TFP-RSB group were generally lower than those in TFP group(P<0.05).VAS scores in TFP-RSB and TFP groups were lower than those in the control group(p < 0.05).The consumption of sufentanil in TFP-RSB group was significantly lower than that in TFP group(p < 0.05).The sleep quality on PQSI in TFP-RSB group was significantly better than that in TFP and blank control groups(P<0.05).The levels of IL-6 in TFP-RSB group were lower than those in TFP Group and control group(p < 0.05).There was no significant difference between the TFP group and the blank control group 24 hours after operation(P>0.05).The level of Apelin13 in the three groups before operation was significantly lower than that in each time period after operation(P>0.05).The serum Apelin13 level in TFP-RSB group was significantly lower than that in TFP group at each postoperative time(P<0.05).Meanwhile,the levels of TFP-RSB and TFP were significantly lower than those of the control group(P<0.05).The rate of postoperative nausea and vomiting in the TFP group(26.6%)was lower than that in the blank control group(50%),but the difference was not statistically significant(P > 0.05).TFP-RSB group(3.3%)was significantly lower than TFP group(26.6%)and blank control group(50%)(P<0.05).Conclusion:Compared with TFP block,TFP-RSB block was more effective in analgesia,less fluctuation of blood glucose and inhibition of inflammatory reaction in patients with diabetes mellitus.