| Part 1 Effect of general anesthesia combined with regional nerve block in patients undergoing laparoscopic resection of colorectal cancer during operationObjective: To study the effects of general anesthesia combined with regional nerve block on patients in anesthetics consumption, stress response, inflammation effects of laparoscopic resection of colorectal cancer during operation.Methods: Ninety cases underwent laparoscopic resection of colorectal cancer, ASA I~Ⅲ, aged 32~65 years old, weight 46~82Kg. Randomly divided into three groups: control group(simple intravenous general anesthesia group, group G), general anesthesia combined with epidural anesthesia group(group GE) and general anesthesia combined with transversus abdominis plane block group(group GT). BIS was monitored during the whole process, systolic blood pressure(SBP) and diastolic blood pressure(DBP), heart rate(HR) were recorded before anesthesia(T0, after entrancing into the operative room and calm for 10 min), before endotracheal intubation(T1), after endotracheal intubation(T2), skin incision(T3), 5 min after skin incision(T4), 5 min after the establishment of artificial pneumoperitoneum(T5), at the end of operation(T6), propofol and remifentanil consumptions were recorded, the plasma concentration of norepinephrine(NE), cortisol(Cor), leucocyte interleukin 6(IL-6) and tumor necrosis factor alpha(TNF-α) at T0, T4, T6 were detected by ELISA method.Results: The SBP, DBP, HR were higher in group G than group GE and group GT at T4 and T6(P<0.05). There was no significant diference between three groups in BIS and propofol plasmas concentration when the patient’s consciousness was lost(P>0.05). The total dosage consumption and time dosage consumptions of propofol and remifentanil were lower in group GE and group GT when compared with group G(P<0.05). The fentanil consumption was highest in group G when compared with group GE and group GT. The increasing level of plasma concentration of NE and Cor at T4 and T6 was lower in group GE and group GT(P<0.05). The increasing level of plasma concentration of IL-6, TNF-α at T6 in group GE and group GT was lower than group G(P<0.05).Conclusion: General anesthesia combined with regional nerve block can maintain stable hemodynamics, reduce the dosage consumption of propofol and remifentanil in laparoscopic resection of colorectal cancer, reduce the surgical stress response, and decrease inflammatory cytokine release.Part 2 Effect of general anesthesia combined with regional nerve block on postoperative recovery in patients undergoing laparoscopic resection of colorectal cancerObjective: To study the effects of general anesthesia combined with regional nerve block on postoperative stress response, inflammation, analgesia, pain score, and the effect of postoperative recovery of patients with laparoscopic resection of colorectal cancer.Methods: Ninety cases underwent laparoscopic resection of colorectal cancer, ASA I~Ⅲ, aged 32~65 years old, weight 46~82Kg. Randomly divided into three groups: control group(simple intravenous general anesthesia group, group G), general anesthesia combined with epidural anesthesia group(group GE) and general anesthesia combined with transversus abdominis plane block group(group GT). Patients in group G and group GT were postoperative analgesia with fentanyl 0.5mg and flurbiprofen axetil 150mg(diluted with normal saline to 150ml), background dosage was 3ml/h, PCA 3 ml per time, locked time was 20 min; patients in group GE were postoperative analgesia with fentanyl 0.4mg and 0.75% ropivacaine 30 ml(diluted with normal saline to 150ml), background dosage was 3ml/h, PCA 3 ml per time, locked time was 20 min. Observed patients’ postoperative spontaneous breathing recovery time, awake time, extubation time, in three groups. The BP, HR, VAS score, were recorded at the end of operation(T6), 6 hours(T7), 24 hours(T8) and 48 hours(T9) after operation; time for the first time pressing the analgesia pump, effective pressing numbers of 0-12 h, 12-24 h, 24-48 h after operation of the PCA were recorded; the postoperative nausea and vomiting, anal exhaust time, time of removal of the urinary catheter, and hospitalization time were follow-up. The plasma concentration of norepinephrine(NE), cortisol(Cor), leucocyte interleukin 6(IL-6) and tumor necrosis factor alpha(TNF-α) at 6 hours, 24 hours and 48 hours after operation were detected by ELISA method. And plasma motilin(MTL) at 24 hours and 48 hours after operation were detected by ELISA method.Results: The spontaneous breathing recovery time, awake time, extubation time in group GE and group GT were shorter than group G(P<0.05); the SBP, DBP, HR at T6, T7, T8 in group G were higher than group GE and group GT(P<0.05); the VAS score at T6, T7, T8 in group G were higher than group GE and group GT(P<0.05); time for the first time pressing the analgesia pump in group GE and group GT were longer than group G, and the group GE was longest(P<0.05). The effective pressing numbers of the PCA between 0-12 h, 12-24 h postoperatively in group G were more than group GE and group GT(P<0.05). The time of removal of the urinary catheter in group GE was longer than group G and group GT(P<0.05). The increasing level of plasma concentration of IL-6 and TNF-α at T8 and T9 in group GE and group GT were lower than group G(P<0.05).Conclusion: General anesthesia combined with regional nerve block can improve postoperative analgesic efficacy in patients undergoing laparoscopic resection of colorectal cancer, reduce the postoperative consumption of opioid, reduce the release of inflammatory cytokines, inhibit the stress reaction within 48 hours after operation, has a positive protective effect for patients, it can be used as a choice of postoperative analgesia. |
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