The Clinical Study Of Abdominal Wall Nerve Block Combined With Remifentanil For Cardiovascular Patients Receiving Peritoneal Dialysis Catheter Implantation

ObjectiveTo observe the analgesic effect and adverse reactions of ultrasound-guided abdominal wall nerve block(including transversus abdominal plane block and rectus sheath block)combined with remifentanil for cardiovascular patients receiving peritoneal dialysis catheter implantation,and explore its efficacy and safety.MethodsA total of 60 cardiovascular patients[ASA physical status ?~?),scheduled for elective peritoneal dialysis catheter implantation,were randomly divided into normal saline group[group Ro)and remifentanil group(group Ri).Before abdominal wall nerve block,Group R1 were infused with a target controlled infusion(TCI)of remifentanil at 2ng/ml while the group R0 were infused with the same volume of normal saline.Remifentani or normal saline stopped at the end of the operation.The patients were both treated with unilateral transversus abdominal plane block[0-3%ropivacaine 20ml)and rectus sheath block(0.3%ropivacaine 8ml]under ultrasound-guidance.Mean arterial pressure(MAP),respiratory rate(RR)>heart rate[HR),Sp02,alertness/sedateon(OAA/S)scale and pain scores(VAS)were recorded at the different time during the operation:pre-block(T0],during nerve block(Ti),skin incision[T2],muscle separation[T3],lifting and incising peritoneum[T4),catheterization(T5],forming subcutaneous tunnel[T6),skin closure(T7).The number of patients alterating to general anesthesia and requiring remediation,the satisfaction to the effect anesthesia by the patients needed to be recorded.The occurrence of adverse events related to abdominal wall nerve block and remifentanil were also recorded.Incidence of adverse cardiac events were recorded intraoperative and 24 hours postoperative.ResultsAll patients successfully completed the operation,and no patient needed to be transferred for general anesthesia.MAP,HR,RR in the R1 Group were significantly lower than in the Ro Group(P<0.05),while there was no significant difference in Sp02 between the two groups(P>0.05).The VAS scores at the time points of T3-7 were significantly lower than in the Ri Group compared to the Ro Group.There were no significant changes in the VAS scores at 24 hours after surgery(P>0.05).The Ri Group showed a higher satisfaction of the patients(73%vs.47%)and needed less remediation(5 patients vs.11patients)(P<0.05).There were no relevant differences in adverse reactions and complications(P>0.05).ConclusionAbdominal wall nerve block can provide effective analgesia for patients undergoing peritoneal dialysis catheter implantation.Sedative and analgesic effects of remifentanil can significantly relieve pain during operation,improve the patient experience and not increase the incidence of adverse reactions and complications.Abdominal wall nerve block combined with remifentanil is safe and effective for cardiovascular patients in peritoneal dialysis catheter implantation.