Effect Of Multimodal Analgesia On Postoperative Insulin Resistance In Patients With Colorectal Cancer

Objective: To investigate the effects of multimodal analgesia on postoperative insulin resistance in patients with colorectal cancer.Methods: A total of 120 patients undergoing radical resection of colorectal cancer were randomly divided into three groups: Patient intravenous controlled analgesia group(PCA group,n=40),Transversus abdominis plane block group(TAP group,n= 40),Epidural analgesia group(GEA group,n=40).PCA group with general anesthesia+postoperative intravenous analgesia;TAP group with general anesthesia+transversus abdominis plane block analgesia;GEA group with general anesthesia+postoperative epidural analgesia.All patients were intravenously injected with paracoxib for 30 min before surgery.Fasting plasma glucose(Glu),interleukin-6(IL-6)and insulin(FINS)concentrations were measured at 1 day before anesthesia,after removal of endotracheal tube at the end of surgery,and on the 1st and 2nd day after operation.Hemeostasis Model assessment(HOMA)values were also calculated.Visual Analogue Score(VAS)were assessed at 2,8,12,24,36,48 h after surgery.Results: The three groups were compared,1.TAP group and GEA group postoperative VAS score was significantly lower than the PCA group,there was a significant difference(P <0.05);2.TAP group and GEA group FPG,FINS,IL-6 was lower than that of PCA group(P <0.05);3.The insulin resistance of TAP group and GEA group was lighter than that of PCA group,HOMA value was significantly different(P <0.01);4.Compared with TAP group,there was no significant difference in postoperative VAS score between TAP group and GEA group(P> 0.05).5.Compared with TAP group,the levels of FPG,FINS and IL-6 in GEA group were lower(P <0.05);6.Compared with TAP group,the insulin resistance of GEA group was lighter and the HOMA value had significant statistical difference(P<0.05).7.There was no difference between the general data of each group(P>0.05).Conclusions: Compared with traditional intravenous analgesia,multimodal analgesia can reduce postoperative VAS score and relieve postoperative pain effectively;2.Perioperative multimodal analgesia can reduce postoperative IR Extent;3.Transversus abdominis plane block analgesia and epidural analgesia can provide satisfactory postoperative analgesia for patients with colon cancer,but in reducing postoperative IR in patients with colorectal cancer,the epidural analgesia is superior to transversus abdominis plane block analgesia.