Effect Evaluation On The Different Concentration Of Ropivacaine TAPB In Laparoscopic Gynecologic

Objective: To discuss the effect of different concentration ropivacaine group transversus abdominis plane block(TAPB)on the intraoperative opioid drugs and postoperative analgesic dosage in laparoscopic gynecologic surgery and to provide reference for the choice of anesthesia methods and postoperative analgesia.Methods: Eighty patients,ASA I or II,underwent elective laparoscopic gynecologic surgery from December 2014 to February 2016,were randomly divided into four groups : general anesthesia group(Group C),general anesthesia +0.25% ropivacaine group(group R1),general anesthesia +0.375% ropivacaine group(group R2)and general anesthesia + 0.5% ropivacaine group(group R3)group,and 20 cases in each group.All patients were opened upper extremity venous channels after entering the operating room and the basic vital signs were routinely monitored including BP,HR,ECG,SPO2 and BIS.The indices such as BP and HR were continuously measured three times and calculated the average value as the basis.General anesthesia induction was performed according to the uniform standard.Ultrasound-guided bilateral TAPB was done 5 minutes after intubation.Twenty milliliter of 0.25% ropivacaine was used each side in group R1,20 ml of 0.375% ropivacaine used each side in group R2,20 ml of 0.5% ropivacaine used each side in group R3,and no ropivacaine used in group C.These operations were completed by the same anesthetist.The surgical procedures were stared 15 minutes after TAPB.Propofol and cisatracurium were intravenous infused by injecting pump during operation in order to maintain a BIS value between40-60.All patients were given PCIA after surgery.Four groups were compared in sufentanil dosage during the operation and postoperative PCIA within 24 hours,the first pressing the analgesia pump time and pressing number,TAPB to operation end time,stopping infusion of propofol to extubation time,postoperative 4,8,12,24hours VAS score(on a scale of 0-10),cases of complications related to TAPB and cases of postoperative nausea and vomiting.Results: Four groups had no significant difference in age,weight,height,operation time and postoperative 12,24 hours VAS score(P>0.05).Compared with general anesthesia group,the sufentanil dosage during the operation and postoperative PCIA within 24 hours reduced(P<0.05),stopping infusion of propofol to extubation time shortened(P<0.05),postoperative4,8 hours VAS score decreased(P<0.05),the first pressing the analgesia pump time prolonged(P<0.05),pressing number reduced(P<0.05)and postoperative nausea and vomiting incidence decreased(P<0.05)in other three groups.Compared with group R1,the sufentanil dosage during the operation reduced(P<0.05),the sufentanil dosage postoperative PCIA within 24 hours reduced(P<0.05),stopping infusion of propofol to extubation time shortened(P<0.05),postoperative 4,8hours VAS score decreased(P<0.05),the first pressing the analgesia pump time prolonged(P<0.05),pressing number reduced(P<0.05).But these three groups had no significant difference in TAPB to operation end time and the incidence of postoperative complications.The differences in all aspects of the above were not statistically significant between group R2 and R3.Conclusion:(1)Ultrasound guided TAPB can significantly reduce intraoperative and postoperative opioid dosage,and can be used as a combined anesthesia mode of general anesthesia.(2)Considering the effect of analgesia and complications,0.375%ropivacaine is more suitable for TAPB in gynecological laparoscopic surgery.