Effect Of The Transversus Abdominis Plane Block With Flurbiprofen Axetil On Postoperative Analgesia In Patients Undergoing Ambulatory Gynecologic Laparoscopic Surgery

Backgroud and objectiveWith the development of enhanced recovery after surgery?ERAS?and comfort diagnostic and therapeutic procedure,both doctors and patients are seeking more comfortable medical treatment.To improve the comfort of surgical patients,the perioperative anesthesia management is particularly important.The ambulatory surgery mode can shorten the hospitalization time of patients,reduce the medical expenses and the rate of nosocomial infection.It's widely promoted in China.Multidisciplinary team?MDT?and minimally invasive surgery also promote the development of ambulatory surgery.However,postoperative pain and postoperative nausea and vominting?PONV?are still the main factors for delayed discharge of ambulatory surgery.Postoperative pain is acute pain that occurs immediately after surgery.It not only causes increased oxygen consumption,but also has an effect on cardiovascular and respiratory system function.It can also lead to psychological illness such as anxiety,phobia and sleep disturbances.If can't be controlled,it can develop into chronic pain,resulting in a decline in the quality of patients'life.Appropriate postoperative analgesia is better to the recovery after surgery.The traditional postoperative analgesia includes epidural analgesia and intravenous analgesia,but each method has its own limitation.Multimodal analgesia?MMA?is a method that combines different mechanisms analgesics and different analgesia methods to block the pain and it's a kind of analgesic concept that is currently advocated.The concept promotes patients'early recovery with maximum analgesic efficacy and minimal adverse reactions.Transversus abdominis plane block?TAPB?is a regional nerve block technique that injects local anesthetic into the internal oblique and transverse muscles of the abdomen to provide analgesia for anterior abdominal wall skin,muscle,and parietal peritoneum.In order to promote the development of day surgery and EARS,this study was designed to evaluate the effect of the TAPB with flurbiprofen axetil on postoperative analgesia in patients undergoing ambulatory gynecologic laparoscopic surgery with the guidance of multimodal analgesia.MethodA total of 90 cases of gynecologic surgery patients undergoing elective laparoscopic surgery were included.All the patients of the three groups received general anesthesia.90 patients were randomly divided into three groups by random number table,TL group?transversus abdominis plane block group with ropivacaine concentration of 0.25%,n=30?,TLF group?transversus abdominis plane block combined flurbiprofen axetil group with ropivacaine concentration of 0.25%,n=30?and THF group?transversus abdominis plane block combined flurbiprofen axetil group with ropivacaine concentration of 0.375%,n=30?.TL group received ultrasound-guided bilateral posterior TAPB with each side was injected with 0.25%ropivacaine 15 mL before anesthesia induction;TLF group received ultrasound-guided bilateral posterior TAPB with each side was injected with 0.25%ropivacaine 15 mL followed by intravenous injection of flurbiprofen axetil 1 mg/kg before anesthesia induction;THF group received ultrasound-guided bilateral posterior TAPB with each side was injected 0.375%ropivacaine 15 mL followed by intravenous injection of flurbiprofen axetil 1 mg/kg before anesthesia induction.30minutes After TAPB,the block plane was detected and the anesthesia incuction was set about.The mean arterial pressure?MAP?and heart rate?HR?were recorded in the three groups of patients at the time of coming into the operate room?T₁?,5 minutes after anesthesia induction?T₂?,5 minutes after the completion of abdominal puncture?T₃?,completion of the surgery?T₄?and 3 hours after the surgery?T₅?.The operation time and anesthetic maintenance dosage were recorded.The visual analogue scale?VAS?of pain and PONV was evaluated at 3,6,12 and 24 hours after the operation.The number of patients accepting rescue analgesia in the three periods and the patient's hospital stay were recorded in the three groups.At the same time,the incidences of pruritus,respiration depression,local anesthetic intoxication,local anesthetic allergy and organ damage were recorded.ResultThere was no significant differences in age,weight,height,ASA grade,the block plane of TAPB and the time of operation among the three groups?P>0.05?.Compared with the TL group,anesthetic maintenance dosage and length of hospital stay in the TLF and THF groups were decreased?P<0.05?.There was no significant differences in anesthetic maintenance dosage and the length of hospital stay between the THF and TLF groups?P>0.05?.At T₃,the MAP of TL group was significantly higher than that of TLF and THF groups,and the MAP of the three groups was significantly higher than that of T₂?P<0.05?.At T₃,the HR of the TL group was significantly higher than that of the TLF and THF groups and the HR of the TL group was significantly higher than that of the T₂?P<0.05?.At 3 hours postoperative,compared with TLF and THF groups,the VAS of pain was higher in the TL group.At 6 hours after surgery,the VAS of pain in the TL and TLF groups was higher than that of THF group.At 12 hours after the surgery,the VAS of pain in TL group is higher?P<0.05?.Within 3 hours after surgery,The number of patients accepting rescue analgesia in the TLF and THF groups was smaller than that of TL group;Within 3⁶ hours after surgery,The number of patients accepting rescue analgesia in the THF group was lower than that of TL group,and the difference was statistically significant?P<0.05?.There was no difference in the score of PONV?P>0.05?.One patient in the postoperative TL group had mild pruritus?P>0.05?.There were no respiratory depression and adverse reaction caused by the puncture of transversus abdominis plane block of the three groups?P>0.05?.Conclusions1.Ultrasound-guided transversus abdominis plane block combined with flurbiprofen axetil reduced the use of postoperative analgesic drugs,provided effective postoperative analgesia for ambulatory gynecologic laparoscopic surgery.2.Transversus abdominis plane block with 0.375%ropivacaine combined with flurbiprofen axetil has better effect of postoperative analgesia.