Analgesic Effect Of Different Concentrations Of Ropivacaine With Quadratus Lumborum Block After Laparoscopic Hysterectomy

BackgroundCompared with the traditional open operation,laparoscopic hysterectomy?LAH?which belongs to the minimally invasive surgery,has none-postoperative pain.However,a growing number of research reports and feedback surveys show that even with less invasive laparoscopic surgery,postoperative incision pain and pneumoperitoneum pain syndrome can lead to acute postoperative pain in patients,which is no less than traditional open surgery.Quadratus lumborum block?QLB?,as one of the effective methods of postoperative multi-mode analgesia,has been widely used in postoperative analgesia after abdominal surgery.ObjectiveTo explore the analgesic effect of different concentrations of ropivacaine in quadratus lumborum block?QLB?in laparoscopic hysterectomy?LAH?,in order to provide a basis for analgesia after LAH.MethodsFrom February 2019 to December 2019,120 patients who were from the four hospital of Xinxiang Medical University underwent laparoscopic hysterectomy were randomly divided into four groups:A,B,C,and D,30 cases in each group.All groups underwent intravenous general anesthesia,among them,groups B,C,and D underwent bilateral QLB under ultrasound guidance,20 ml ropivacaine on each side.Group A?control group?,group B?0.15%ropivacaine?,group C?0.25%ropivacaine?,and group D?0.33%ropivacaine?.The four groups were observed and recorded for:?1?Pain severity?VAS?scores of rest and exercise at 6 h?T₁?,12 h?T₂?,24 h?T₃?,and 48 h?T₄?after surgery.?2?Comfort level?BCS?score at T_1-4.?3?Additional numbers of nalbuphine within 48h after surgery.?4?Concentrations of substance P?SP?and serotonin?5-HT?in peripheral blood at the end of the operation?T₀?and T_1-4.?5?Incidence of postoperative dizziness,nausea and vomiting.?6?Satisfaction degree of analgesia.Results1.There was no significant difference in the VAS scores of group B,C and D at rest and exercise at T_1-3?P>0.05?,with the extension of time in group A,the higher the VAS score at rest and during exercise,the difference was statistically significant?P<0.05?;the VAS scores of the four groups at time T₄ at rest and during exercise were higher than those at time T₃,and the differences were statistically significant?P<0.05?,the VAS scores of group B,C and D at rest and exercise at T_1-4-4 were lower than those of group A,and those of group C and D were lower than those of group B?P<0.05?,but there was no significant difference in the VAS scores of group C and D at rest and exercise at T_1-4?P>0.05?.2.There was no significant difference in BCS score between groups B,C and D at T_1-3-3 time?P>0.05?,with the extension of time in group A,the lower the BCS score,the difference was statistically significant?P<0.05?;the BCS scores at time T₄ in the four groups were lower than those at time T₃,and the difference was statistically significant?P<0.05?;the BCS scores of groups B,C,and D at T_1-4-4 were higher than those of group A,and those of groups C and D were higher than those of group B,the difference was statistically significant?P<0.05?,but there was no significant difference in the BCS scores at time T_1-4-4 between groups C and D?P>0.05?.3.The number of additions of nalbuphine within 48 hours after surgery was less in groupB,C,and D than in group A,and the number of additions of nalbuphine within 48hours after surgery in groups C and D was less than that in group B,the difference was statistically significant?P<0.05?;there was no significant difference in the number of additions of nalbuphine within 48 hours after surgery between groups C and D?P>0.05?.4.There was no significant difference in the concentration of SP and 5-HT at the time of T₀ between the four groups?P>0.05?;there was no significant difference in the concentration of SP and 5-HT at the time of T_1-3-3 among groups B,C and D?P>0.05?,but the concentration of SP and 5-HT in group A was higher with time prolonging?P<0.05?;the concentration of SP and 5-HT at T₄ was higher than that at T₃ in the four groups,and the difference was statistically significant?P<0.05?,the concentrations of SP,5-HT in groups B,C and D at time T_1-4-4 were lower than those in group A,and those in groups C and D were lower than those in group B,the difference was statistically significant?P<0.05?,but there was no significant difference in SP and 5-HT concentrations between groups C and D at time T_1-4?P>0.05?.5.There was no significant difference in the incidence of dizziness,nausea and vomiting within 48 h after operation among the four groups?P>0.05?.6.Compared with the analgesia satisfaction of the four groups,the difference was statistically significant?P<0.05?,the analgesia satisfaction of B,C and D was higher than that of group A,and the analgesia satisfaction of groups C and D was higher than that of group B,and the difference was statistically significant?P<0.05?,there was no significant difference in analgesia satisfaction between groups C and D?P>0.05?.ConclusionAfter laparoscopic hysterectomy,bilateral QLB with 0.25%and 0.33%ropivacain-e showed significant analgesic effect.