| Objective:In our study.we aimed at investigating the effects of MMA and traaitional analgesic methods on postoperative pain treatment and postoperative recovery of patients with primary liver cancer undergoing hepatocarcinoma resection in the concept of ERAS.And then found a better analgesic scheme that alleviated the physical and mental pain of patients,reduced the economic burden of diseases on patients' families,hospitals and society,promoted the better implementation of ERAS in perioperative period of liver cancer,and improve the prognosis of patients.Methods:According to certain prospectively determinate inclusion and exclusion criteria,the clinical data of 66 patients who underwent liver cancer resection from December 2016 to December 2018 were analyzed by prospective study method.The diseases of the patients in the study were primary liver cancer.During hospitalization.the operation,anesthesia and postoperative rehabilitation of the patients were managed by the same team according to ERAS programmes.Sixty-six patients were randomly divided into MMA group(epidural analgesia plus multi-point transversus abdominis plane block under costal margin by ultrasound guidance and incision infiltrating)with 34 cases and traditional analgesia group(intravenous patient controlled analgesia plus on-demand analgesia)with 32 cases by random number table.The dates of the two groups were compared and evaluated,which including general preoperative indexes,intraoperative conditions,postoperative recovery.postoperative pain score,hospitalization expenses,hospitalization time,postoperative complications and readmission rate within one month.Results:(1)intraoperative situation:The hepatocarcinoma resection of two groups were completed by the same surgeon and anesthesiologist team.There was no patient died and entered the intensive care unit during the preoperative period.In MMA group,there were 7 cases with tumor location?3 liver segments and 27 cases with tumor location<3 liver segments.In the traditional analgesia group.there were 5 cases with tumor location?3 liver segments and 27 cases with tumor location<3 liver segments,the difference between the two groups was not significant(P>0.05).There was no significant difference between the two groups in blood glucose,bleeding volume,intraoperative fluid supplement,hepatic portal blocking time,tumor size,operation time.and the method of tumor resection(P>0.05).(2)general indexes of laboratory examination after operation:There was no significant difference in blood glucose,WBC.HGB.TBil.DBil.ALT.AST between the two groups on the 1st.3rd and 5th day after operation(P>0.05);(3)pain scores of different states after operation:The differences of pain scores of MMA group and traditional analgesia group on the day after operation(2.1±0.7 vs.3.0±0.4),bed rest and exercise pain scores(1.8±0.6 vs.3.1±1.0 and 2.5±0.6 vs.3.8±0.9)on the first day after operation.bed rest,exercise and bedtime pain scores(2.3±1.2 vs.3.3±0.8,2.8±1.0 vs.3.7±0.8 and 1.3±0.6 vs.2.1±1.1)on the second day after operation,the scores of bed rest and exercise pain(1.6±0.5 vs.2.4±0.9 and 2.1±1.1 vs.2.9±0.8)on the third day after operation and the scores of exercise pain(1.9±0.7 vs.2.3±0.6)on the fourth day after operation were statistically significant(P<0.05).(4)postoperative functional recovery:The first postoperative exhaust time in MMA group and traditional analgesia group were(35.3±14.8)h.(57.8±14.8)h respectively,the first postoperative defecation time were(59.3±15.9)h,(94.5±28.6)h respectively,the first postoperative eating time were(38.1±16.8)h,(5 1.8±13.8)h respectively,and the first postoperative ambulation time were(45.9±16.0)h and(81.0±25.7)h respectively,the differences were statistically significant(P<0.01).However,there was no significant difference between the two groups in terms of the time of pulling out the catheter and drainage tube(P>0.05).(5)satisfaction degree of pain control,hospitalization days and hospitalization expenses:Satisfaction degree of pain control in MMA group and traditional analgesia group were(8.5±0.7)and(8.0±0.9)respectively,and the difference was statistically significant(P<0.01).There was no significant difference in hospitalization expenses,total hospitalization days and actual hospitalization days between the two groups(P>0.05).The theoretical hospitalization days after operation in MMA group and traditional analgesia group were(8.8±3.1)d and(10.4±3.6)d respectively,the difference was statistically significant(P<0.05).(6)postoperative complications and coagulation indexes:there was no significant difference between the two groups in postoperative complications,postoperative platelet(PLT)and international normalized ratio(INR)(P>0.05)Conclusion:The MMA that based on epidural analgesia,combined multi-point TAPB under costal margin by ultrasound-guided and incision infiltrating in the perioperative period of liver cancer surgery can reduce early postoperative pain.improve patients' satisfaction with pain control,promote the implementation of ERAS other strategies and conducive to the recovery of postoperative function of patients when compared with traditional analgesia method based on intravenous patient-controlled analgesia pump.At the same time.MMA are safe and effective in the perioperative period of liver cancer surgery. |
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