Effect Of Bilateral Rectus Sheath Block On Postoperative Analgesia In Patients Undergoing Open Radical Gastrectomy

Objective Postoperative pain?PP?is a response to injury stimulation caused by the trauma of the operation.Postoperative pain can not only cause the increase of blood pressure,abdominal muscle tension and incision fracture,but also cause psychological and emotional changes such as depression and irritability.Therefore,postoperative pain is not conducive to recovery.The postoperative pain was severe in patients with open radical gastrectomy.However,the patients with radical gastrectomy were older and multiple complicated,and the use of epidural analgesia and intravenous analgesia were limited,and the postoperative analgesia effect was not perfect.Ultrasound-guided rectus sheath block?RSB?can block the abdominal wall nerve,improve postoperative analgesia and accelerate the recovery of surgical patients.The purpose of this study was to evaluate the effect of bilateral rectus sheath block on postoperative analgesia in patients undergoing open radical gastrectomy.Methods A total of 50 patients,aged 50 to 75 years,with a body mass index?BMI?of18.5-24 kg/m² and grade?-?of ASA were selected.The patients were randomly divided into two groups:control group?group C?and rectus sheath block group?group R?.In group C,0.5%ropivacaine 20 mL was injected into the posterior sheath of both rectus abdominis.The patients in group C were injected with normal saline in the posterior sheath of bilateral rectus abdominis.Then intravenous injection of midazolam0.025 mg·kg^-1,sufentanil 0.2-0.4?g·kg^-1,etomidate 0.1-0.2 mg·kg^-1 and rocuronium0.6-0.9 mg·kg^-1 were induced by general anesthesia and then intubated with anesthetic mechanical ventilation to maintain P_ETCO₂ 35-45 mmHg.Propofol 4-6mg·kg^-1·h^-1,remifentanil 10-20?g·kg^-1·h^-1 and dexmedetomidine 0.2?g·kg^-1·h^-1were added intermittently to maintain muscle relaxation with cisatracurium,and BIS was maintenance at 40-60.After operation,patient controlled intravenous analgesia?PCIA?was used.The resting and movement VAS scores,ramsay sedation score,accumulative compression times of PCIA and the amount of extra analgesic were recorded at 1,6,12,24 and 48 hours after operation to evaluate the analgesic effect.The number of patients with nausea and vomiting,dizziness,drowsiness and respiratory inhibition were recorded to evaluate the adverse effects of postoperative analgesia.ResultsCompared with at postoperative 1 hour,the resting and movement VAS scores were increased at 6,12,24 and 48 hours after postoperation in patients of group C,the resting and movement VAS scores were increased at 24 and 48 hours after postoperation in patients of group R?P<0.05?.Compared with group C,the resting and movement VAS scores were decreased in postoperative 6 and 12 hours in group R?P<0.05?.Compared with at postoperative 1 hour,the frequency of PCIA were increased at6h,12h,24h and 48h after postoperation in patients of group C,the frequency of PCIA were increased at 12,24 and 48 hours after postoperation in patients of group R?P<0.05?.Compared with group C,the frequency of PCIA were decreased in postoperative6,12,24 and 48 hours in group R?P<0.05?.Compared with at postoperative 1 hour,the consumption of additional analgesic drugs increased significantly 24 and 48 hours after operation in group C?P<0.05?,the consumption of additional analgesic drugs increased significantly 24 and 48 hours after operation in group R?P<0.05?.There was no significant difference in the consumption of additional analgesic drugs between the other time points and the two groups?P>0.05?.There was no significant difference in ramsay sedation scores between the two groups?P>0.05?.There was no significant difference in postoperative nausea and vomiting,dizziness,drowniness and respiratory inhibition between the two groups?P>0.05?.Conclusion Ultrasound-guided bilateral rectus sheath block can effectively reduce the early VAS score,the times of intravenous pump compression and the amount of extra analgesic drug in patients with open radical gastrectomy.Ultrasound guided bilateral rectus sheath block did not increase the adverse events of postoperative analgesia,such as respiratory inhibition,drowsiness,dizziness,nausea and vomiting.Therefore,ultrasound guided bilateral rectus sheath block can relieve the pain after open radical gastrectomy and improve the early postoperative patient controlled intravenous analgesia.