Application Of Preemptive Analgesia Of Ultrasound-guided Transversus Abdominis Plane Block Combined With Oxycodone In Natients Undergoing Kidney Transplantation

Objective:To observe the optimal effect of ultrasound-guided abdominis transverse plane block combined with oxycodone preemptive analgesia for postoperative analgesia in renal transplant patients.Method:Ninety patients with uremia who received a living kidney transplant were selected with ASA III,22-45 years old,,weight 45-75 kg.They were randomly divided into 3 groups?n=30?blank control group?group C?,TAP block group?TAP group?and TAP block+oxycodone group?TAP+O group?.After entering the operating room,routine monitoring of BP,HR,SpO2,ECG and body temperature.The peripheral Venous infusion channel?the upper limb avoided a-v fistula?was opened,0.4mg of penehyclide hydrochloride was injected intravenously,and under local anesthesia,radial artery puncture and catheterization was performed to monitor the Invasive arterial blood pressure?IBP?,and right internal jugular vein puncture and catheterization was performed to monitor the Central Venous pressure?CVP?.The depth of anesthesia was monitored using a Narcotrend monitor?MT,Germany?.The TAP group and the TAP+O group were blocked by Transversus abdominis plane?TAP?30 min before induction of general anesthesia,and 0.375%ropivacaine 20 ml+5 mg dexamethasone mixture was injected.Intravenous injection of midazolam,target-controlled infusion of remifentanil and propofol,intravenous injection of cis-atracurium to induce anesthesia,and mechanical ventilation was performed after placing the laryngeal mask,and PETCO2was maintained at 35⁴5 mmHg.Intravenous infusion of propofol and remifentanil,inhalation of sevoflurane for anesthesia,intermittent intravenous injection of cis-atracurium for muscle relaxations,and intraoperative Narcotrend values of 37⁴6were maintained.In the TAP+O group,oxycodone hydrochloride 0.1 mg/kg was intravenously administered 20 min before the end of surgery.After the operation,sufentanil 1.5 ug/kg?diluted to 100 m1 with saline?intravenous controlled analgesia?PCIA?,background infusion rate of 1.5ml/h,PCA dose of 2 ml,locking time At 20min,the Visual Analogue Score?VAS?was maintained at?4 points.Postoperative VAS score and Ramsay score were recorded at 3h?T₁?,6h?T₂?,12h?T₃?,24h?T₄?and48h?T₅?.The intraoperative dosage of remifentanil and the effective PCIA compressions within 24 h after surgery were recorded.Blood samples from the median cubital vein were taken 1 day before surgery,2 days and 5 days after surgery,and the concentrations of serum creatinine?SCr?and blood urea nitrogen?BUN?were measured.The nausea and vomiting,dizziness headache,respiratory depression,excessive sedation,and complications associated with TAP block?hematoma at the puncture site,abdominal organ damage,local anesthetic poisoning?was recorded within 24 hours after surgery.Results:Compared with group C,the VAS scores of T₁ to T₃ at rest and activity were significantly decreased in TAP group and TAP+O group;intraoperative use of remifentanil decreased;the number of PCIA effective compressions decreased within 24h after surgery;serum Cr and BUN concentrations decreased at 2 days postoperatively?P<0.05?.Compared with the TAP group,the VAS scores of T₁ to T₃ at rest and activity were significantly lower and the number of PCIA effective compressions decreased at24 h after surgery?P<0.05?in the TAP+O group.No TAP-related complications occurred in the TAP group and the TAP+O group?P>0.05?.There was no significant difference in the incidence of postoperative nausea and vomiting and dizziness headache between the 3 groups?P>0.05?.Conclusion:Ultrasound-guided TAP block combined with oxycodone preemptive analgesia for patients with renal transplantation can safely and effectively relieve pain after operation,reduce the amount of intraoperative opioids,inhibit postoperative pain sensitivity,and promote the early recovery of renal transplantation patients.