Observation Of Analgesic Effect Of Ultrasound-guided Internal Oblique Plane Block On Laparoscopic Gynecological Surgery

ObjectiveUltrasound-guided transversus abdominis plane(TAP)block has good analgesic effect for abdominal surgery.However,the effect of blocking the internal oblique muscle plane(IOP)by the same nerve has not been reported.This study intends to use the visualization technology of ultrasound to carry out relevant clinical research on the analgesic effect of intra-abdominal oblique muscle fascial block after abdominal endoscopic surgery.MethodsPart one:Aging between 34 and 60 years old with ASA ?-? level,ten patients,who were admitted to our hospital for gynecological abdominal surgery from January 2019 to March 2019,were selected.Bilateral and symmetrical block was carried out before general anesthesia.(1)Puncture block method:in this method,the convenient ultrasonic high-frequency linear array probe with a frequency of 6-13 MHz was adopted.After positioning the intersection of the anterior axillary line and anterior superior iliac spine as puncture point,the probe went up along anterior axillary line,and at the same time identified the external oblique,internal oblique and transverse abdominal.The whole process was done by the same anesthesia physician who adopted lane real-time guidance technology and pierced into the gap between the external oblique and internal oblique plane(IOP).Then after the technology of water separation was used to determine the plane,the drug injected as the needle was inserted was led to spread to the head and end at the rib arch.The drug used is 0.25%of local anesthetics ropiacaine 40 ml(20 ml for both sides respectively).(2)Observation time point:the blocking effect was measured 5min,10min and 20min after injection.(3)Test area:the patient's anterior abdomen was divided into 3 longitudinal lines at the midline of the abdomen and the front line of the left and right axils,4 horizontal lines at the lower margin of the costal arch,the level of the umbilicus,the level of the anterior superior iliac spine,and the level of the upper margin of the pubic symphysis.6 areas are formed by vertical and horizontal lines,which are marked as L1-3 area and R1-3 area.(4)Pain score and classification by acupuncture:3 points,0 points(no pain),1 point(decreased pain)and 2 points(no change in pain).(5)Calculate the mean value of pain score at each time point in each region,and calculate the number and percentage of cases with pain score of 0 or 1 at each time point in each region.Part two:62 patients with gynecological abdominal surgery,admitted to our hospital from January 2019 to June 2019,were selected.They were randomly divided into the IOP group and the TAP group,with 31 cases in each group.The IOP group was treated with abdominal oblique muscle block in the same way as the first part.In the TAP group,a plane block of the transverse abdominis muscle was used.A high-frequency linear array probe of a convenient ultrasound system was used.The puncture point was located at the intersection of the midaxillary line and the iliac crest.When the puncture needle enters the fascial space formed between the internal oblique muscle and the transverse abdominal muscle and it was extended from the midaxillary line from the back to the front.After confirming the correct position of the liquid,the medicine is injected into the lower edge of the costal arch at the same time as the needle was inserted,and 20ml of 0.25%local anesthetic ropivacaine is injected into each side.The efficacy of abdominal oblique muscle block and transverse abdominal muscle block in postoperative analgesia was compared by measuring the range of analgesia,postoperative pain score,the number of cases,postoperative analgesic drug dizocine(>3 points),postoperative analgesia satisfaction,postoperative adverse reactions and various surgical indicators.ResultPart one:L1-R1,L2-R2 and L3-R3 were left and right corresponding areas,and there was no significant difference between the corresponding regions at the same time point after IOP block.At the same time point,no significant difference was found between different areas.In all areas,the score at the 10min time point was lower than that at the 5min time point.In most areas,(except L1 and R1),the score at the 20min time point was lower than that at the 10min time point.The probability that the pain score in each region at each time point is 0 or 1?80%:at 5min,the probability of each region was 0%.At 10min,the probability of 1 minute is 100%,and the probability of 0 minute is 0%,The probability of 1 minute at 20min is 100%,and the probability of 0 minute is 50%.Part two:There was no significant difference in age,sex,BMI and ASA classification between the two groups.Within the same group,there was a significant difference between the two groups in terms of the change in the range of pain reduction at different time points.By 4h after the abdominal oblique muscle plane block,the range of pain reduction had begun to fade.At 6h,most of the reduction range of pain was no more than T10.At 8h,the hypoalgesia range had subsided to below T10 and only a few patients still had symptoms of hypoalgesia.There was no decrease of pain after 12h.The comparison between the two groups at the same time point showed no significant difference in the range of postoperative analgesia between the two groups.There was no statistical difference in theNRS-10 pain score between the two groups under the two states of rest and exercise at each time point after the operation,and there was no statistical difference in the number of cases,postoperative analgesic drug dizocine,postoperative analgesic satisfaction,postoperative adverse reactions and various surgical indicators.ConclusionPart one:At the level of the anterior superior iliac crest in the axillary front,the ultrasound guided internal oblique plane injected 0.25%20ml of the local anesthetic ropivacaine from the human tail to the cephalic end can show a certain degree of analgesia,thus proving the effectiveness of this method.Part two:(1)Internal oblique plane block for lower abdominal postoperative analgesia can provide the same effect as transverse abdominal plane block;(2)The clinical effect and side effects of the internal oblique plane block are similar to that of the transverse abdominis plane block.