| Objectives:1、To analyze the risk factors of pain after laparoscopic radical resection for colorectal cancer.Effect of analgesic mode after laparoscopic bowel cancer radical resection on postoperative pain in patients.To explore the most appropriate postoperative analgesia scheme.2、To investigate the effect of postoperative analgesia on gastrointestinal function,and inflammatory reaction in patients underwent laparoscopic radical resection of colorectal cancer,and thus explore the most suitable postoperative analgesia scheme.Methods:The information of patients who underwent laparoscopic radical resection for colorectal cancer from January 1,2018 to December 31,2022 was reviewed through the anesthetic information system and the medical record inquiry system.A total of 408 cases were counted.Then,study subjects were selected according to the inclusion criteria and exclusion criteria,and 108 patients(15 sent to the ICU after surgery;26 unplanned secondary surgery;30 transit open abdomen;37 indwelling enterostomy)were excluded.Therefore,the medical records of 300 eligible patients who underwent laparoscopic radical resection for colorectal cancer were collected.The 300 patients were divided into four groups according to the analgesia modes after laparoscopic radical resection of colorectal cancer.Group A including 55 patients were treated with intermittent opiate regimen(IOR);Group B including 125 patients were treated with patient-controlled intravenous1analgesia(PCIA);Group C including 60 patients were treated with patient-controlled epidural analgesia(PCEA);and Group D including 60 patients were treated with patient-controlled intravenous analgesia and transversus abdominis plane(PCIA+TAP).Part One: To analyze the risk factors of pain after laparoscopic radical resection for colorectal cancer,and the effect of analgesic modes after laparoscopic bowel cancer radical resection on postoperative pain in patients.The risk factors of postoperative pain after laparoscopic radical resection of colon cancer were analyzed through univariate analysis and multivariate logistic regression analysis.Moderate to severe pain(VAS≥4)was used as a dependent variable,and age,BMI,operation time,anaesthesia time,blood loss,sex,smoking,drinking,ASA grade,type of inhaled anesthetics,pathological stage,surgical site,analgesia mode were included in the binary logistic as an independent variable to find the risk factors of postoperative pain after laparoscopic radical resection of colon cancer.The highest value of VAS and additional analgesia times were compared among the patients with different postoperative analgesia schemes to assess the suitable postoperative analgesia schemes after laparoscopic radical resection of colon cancer.Part Two: To investigate the effect of postoperative analgesia on gastrointestinal function,and inflammatory reaction in patients underwent laparoscopic radical resection of colorectal cancer.Exhaust time,defecation time,drinking time,taking porridge time,preoperative white blood cell count,white blood cell count 24 hours after operation,white blood cell count on the third day after operation,times of taking laxatives,postoperative hospital stay,and postoperative complications were compared among the patients with different postoperative analgesia schemes to assess the suitable postoperative analgesia schemes after laparoscopic radical resection of colon cancer.Results:1.To analyze the risk factors of pain after laparoscopic radical resection for colorectal cancer,and the effect of analgesic modes after laparoscopic bowel cancer radical resection on postoperative pain in patients.1.1 Risk factors of postoperative pain1.1.1 Univariate analysis of postoperative painModerate to severe pain(VAS≥4)was used as a dependent variable,while age,BMI,operation time,anaesthesia time,blood loss,sex,smoking,drinking,ASA grade,type of inhaled anesthetics,pathological stage,surgical site and analgesia mode were included in the binary logistic as an independent variable to find the risk factors of postoperative pain after laparoscopic radical resection of colon cancer.The results showed that age,BMI,pathological stage and analgesia mode(IOR and PCIA)were risk factors of moderate pain.1.1.2 Multivariate analysis of postoperative painThe results of binary logistic regression analysis showed that young age,high BMI,and high pathological stage were risk factors of moderate pain(P < 0.05).The risk of moderate postoperative pain increased by 1.089(1/0.918)times for every one year decrease in age.The risk of moderate postoperative pain increased by 1.402 times for every1 kg/m2 increase in BMI.Compared with stage Ⅰ-Ⅱ,the risk of moderate postoperative pain in stage Ⅲ-Ⅳ was 7.115 times higher.Compared with PCEA,the risk of moderate pain of IOR was 14.087 times,and PCIA was 8.231 times.1.2 Comparison of postoperative pain indexes in the four groupsUnivariate analysis of variance showed that the VAS and the times of supplementary analgesia in IOR group were higner than PCIA group and PCIA+TAP group and PCEA group,and the difference was statistically significant(P < 0.05).Compared with PCIA +TAP and PCEA group,the VAS and the times of supplementary analgesia in PCIA group were higher(P <0.05);Compared with PCEA group,the VAS and the times of supplementary analgesia in PCIA + TAP group were higher.(P <0.05).2 Comparison of postoperative gastrointestinal function recovery and inflammatory response in the four groups.2.1 Comparison of postoperative gastrointestinal function recovery in the four groupsThere was no significant difference in exhaust time and intake water time among the four groups(P >0.05).The defecation time and intake porridge time in PCIA group were significantly higher than those in the other three groups(P < 0.05).There was no significant difference in the defecation time and intake porridge time among the other three groups(P>0.05).The postoperative hospitalization time in IOR group was longer than PCIA group and PCEA group and PCIA+TAP group,and the difference was statistically significant(P <0.05).The postoperative hospitalization time in PCIA group was longer than PCEA group and PCIA+TAP group,and the difference was statistically significant(P < 0.05).There was no significant difference in the postoperative hospitalization time between PCEA group and PCIA+TAP group(P >0.05).The times of laxative administration in PCEA group was higher than those in the other three groups,and the difference was statistically significant(P< 0.05).The times of laxative administration in PCIA group was higher than IOR group and PCIA+TAP group,and the difference was statistically significant(P < 0.05).There was no significant difference in the laxative administration time between IOR group and PCIA+TAP group(P >0.05).2.2 Comparison of postoperative complications in the four groupsThe results of Chi-square test showed that the proportion of febrile and the prevalence of heart failure and postoperative cerebral infarction was not significantly different among the four groups(P > 0.05).2.3 Comparison of white blood cell count in the four groups before and after operationThe results of intra-group comparison showed that the white blood cell count of patients in the four groups 24 hours after operation and 3 days after operation were higher than that before operation(P < 0.05).There was no significant difference in white blood cell count among the four groups before operation,but the white blood cell count 24 hours and 3days after operation in IOR group were higher than PCIA group and PCEA group and PCIA+TAP group(P < 0.05).The white blood cell count 24 hours and 3 days after operation in PCIA group higher than PCEA group and PCIA+TAP group(P < 0.05).There was no significant difference in the white blood cell count among PCEA group and PCIA+TAP group(P >0.05).Conclusion:Young age,high BMI,high pathological stage and analgesia mode(IOR and PCIA)are independent risk factors of postoperative pain after laparoscopic colorectal cancer surgery,so more attention should be paid to these patients about the influence of postoperative pain after laparoscopic colorectal cancer surgery and choose the appropriate analgesic method.Continuous patient-controlled epidural analgesia(PCEA group)and patient-controlled intravenous analgesia add transversus abdominis plane(PCIA+TAP group)are effective analgesic schemes for laparoscopic colorectal cancer surgery.However,PCIA+TAP group has less effect on gastrointestinal function than PCEA group,which is a better scheme for laparoscopic colorectal cancer surgery. |
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