| Background:The cancer occurs in the colon,rectum and anal canal mucosal epithelium is usually called colorectal cancer which has the highest incidence in rectal,followed by sigmoid colon,right colon and left colon.According to the China's latest analysis of the big data on malignant tumors,colorectal cancer incidence rate has increased from the fifth to the fourth place,and the number of patients has increased year by year;meanwhile there shows a younger trend,and the incidence of males is higher than women;the mortality is ranked fifth in the cause of cancer.In 1990s,Jacobs[1]for the first time tried carrying out colorectal surgeries under the total laparoscopic conditions.With the continuous improvement of the equipments and technology,laparoscopic radical resection of colorectal cancer,commonly known as minimally invasive surgery[2.3]is getting more and more acceptions.Relative to the traditional surgery,the amplification of the instrument makes the field more clear and the separation of levels more accurate,so that the cleaning of the operation is more thorough,which has become a treatment option approved by the United States National Cancer Network(NCCN).Laparoscopic surgery has the advantages of less trauma,faster recovery and less postoperative pain than laparotomy,but the pain of the diaphragm and shoulder caused by C02 stimulation is often more severe[4].Usually 2-3 days after surgery the pain is more obvious,which limits the patient's activities,and this postoperative pain is easy to be ignored by medical staff.If the postoperative pain can not get medical staff's attention or ideal treatment,it will cause a certain degree of impact on patients,such as the endocrine system disorder caused by sodium and water retention,rapid heart rate and myocardial oxygen consumption caused by sympathetic nerve stimulation and increased chance of lung infection caused by failure to get out of bed early;what's more,if acute pain can not be effectively controlled,then it could turn into chronic pain,so that patients suffered great physical and mental torture[5.6].Therefore,how to effectively control the postoperative pain of patients with colorectal cancer has become the most prominent and important topic in the era of minimally invasive surgery.Objective:1.Comparison of the NRS(numerical rating scale)scores between the multimodal analgesia group and the intravenous patient-controlled analgesia group after laparoscopic colorectal surgery,including the NRS scores of postoperative 2h,6h,12h,24h and 48h.2.Comparison of the recovery of gastrointestinal function after laparoscopic colorectal surgery in the two groups(the first ambulation time,the first exhaust time,the first defecation time,hospitalization time and total cost.)3.Comparison of the two groups of patients with postoperative anastomotic leakage,bleeding,nausea,vomiting,soft tissue infection,pulmonary infection after laparoscopic colorectal surgery.4.Differences in short-term quality of life scores between the two groups after laparoscopic colorectal cancer surgery.Methods:Choose 94 cases of the patients who received treatment in the the Provincial People's Hospital from March 1,2015 to May,2017,and the patients were all diagnosed with colorectal cancer before the surgeries and underwent the laparoscopic colorectal surgeries.Among the cases,there are 50 cases of the experimental group and 44 cases of the control group(two cases quited with the experiment unfinished).Both groups received the same surgery anesthesia which applies general anesthesia plus continuous subdural anesthesia.Multimodal analgesia group has ropivacaine local infiltration in the skin before skin incision.Postoperative patient-controlled epidural analgesia pumped on day 1 and day after operation;In the control group,the catheter was removed by using a simple intravenous self-control pump at the end of the operation.The postoperative pain was recorded by numeric rating scale(NRS),and the quality of life was assessed by using the quality of life scale at 3 weeks postoperatively.At the same time,the postoperative gastrointestinal function,hospitalization time,total cost and postoperative complications were recorded,and the data were compared between the two groups.Results:The 6h,12h,24h and 48h NRS scores of the multimodal analgesia group were lower than those of the control group(3.05±0.63vs.5.64±1.73;2.91±0.72vs4.95±1.32;2.35±0.48;4.54±0.79;2.15±0.34vs.3.28±0.56),which had statistical significance(P<0.05),NRS score of postoperative 2h was not statistically significant;The first time of ambulation,the time of first exhaust,the time of first defecation,the length of hospital stay and the total cost were lower than those of the control group(2.05± 1.02vs.3.15±1.68;2.83±0.79vs.3.67±1.39;3.59±0.98vs.4.69±1.57;6.35±2.18vs.8.95±2.89;35261±123.9vs.39471±197.5),and the difference was statistically significant(P<0.05).The five functional areas(body function,role function,emotional function),three symptom areas(fatigue,pain,nausea and vomiting),and a single field(insomnia and appetite)in the first three weeks after surgery were significantly different between the(P<0.05).In the cognitive function,social function,shortness of breath,constipation,diarrhea,economic difficulties were not statistically significant.Conclusion:The observation group in endoscopic colorectal cancer radical surgery and postoperative NRS score,gastrointestinal function recovery,complications rate and quality of life score were better than the control group.Applying the injection of local anesthetics before skin incision,postoperative non steroidal anti-inflammatory drugs and epidural analgesia pump is a safe,feasible and effective solution.However,due to the limited number of samples,there needs large scale of samples and multi center data to validate the pattern of multimodal analgesia. |
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