The Application Of Tap Block In Laparoscopic Colorectal Surgery Under ERAS Concept

Objective To investigate the effect of TAP block on analgesic effect and postoperative recovery of patients undergoing laparoscopic colorectal surgery under ERAS concept.Methods After approval by the hospital medical ethics committee and informed consent of the patient's family and the patient,90 patients of colorectal surgery with age ? 75 years old,ASA II-III in our hospital from December 2018 to December2019.They were randomly divided into three groups,30 in each group.The three groups all adopted the same preoperative preparation.Patients received bilateral TAP block(0.25% ropivacaine 20 ml each)15min before skin incision after general anesthesia in group Pr,Patients received bilateral TAP block(0.25% ropivacaine20 ml each)immediately after operation in group Po,and patients received bilateral TAP block(0.9% normal saline 20 ml each)same as group Pr in group C which was the control group.Blood glucose level were collected into the operating room(t0),1hour after the start of surgery(t1),end of the surgery(t2),and 2 hours after operation(t3)respectively.The dosage of sufentanil and remifentanil during the operation was recorded.Record the number of postoperative analgesics added,the number of times the analgesic pump was pressed,the first exhaust,the first defecation time,hospital stay length and total operation cost.The VAS scores at the resting status and movement status were recorded at 0h(T0),6h(T1),12h(T2),24h(T3)and 48h(T4)after operation.The number of postoperative nausea and vomiting,respiratory depression,hematoma and infection at puncture site,and other adverse reactions as well as severe complications were recorded.Results The general data of the three groups were not statistically significant.Compared with t0,the blood glucose of the three groups of patients increased significantly at t1,t2 and t3.Compared with group C,the blood sugar is lower at t2 and t3 in group Pr and lower at t3 in group Po.Compared with group Po,The blood sugar level in lower at t2 and t3 in group Pr.In terms of the amount of remifentanil used during the operation,compared with group C and group Po,the amount of remifentanil used was significantly reduced,and the difference was statistically significant in group Pr.Compared with group C,the pressing times of postoperative intravenous automatic analgesia pump were significantly reduced in group Pr and group Po.In the postoperative static VAS score,there was no statistical difference in the scores of the three groups of patients at T0 and T4.Compared with group C,the VAS scores of group Pr at T1 and T2 were significantly lower,with statistical significance.VAS scores of group Po at T1,T2 and T3 were significantly lower,with statistical significance.In the postoperative dynamic VAS score,at T3 and T4,there was no statistical difference in the scores of the three groups of patients.Compared with group C,the score of group Pr at T0,T1 and T2 were significantly lower,with statistical significance.The score of group Po decreased significantly at T1 and T2.There was no statistical significance in defecation time,hospital stay length and severe postoperative complications among the three groups.Compared with group C,the incidence of nausea and vomiting group was significantly lower in group Pr and group Po.As for compared with group C,postoperative exhaust time is significantly shorter in group Pr and group Po.Conclusion 1.TAP block under ERAS concept can provide effective analgesia for about 24 hours when applied to laparoscopic colorectal surgery,and is helpful for rapid recovery of gastrointestinal tract and reduction of operation cost.TAP block may be an economical and effective method to improve the quality of laparoscopic colorectal surgery.2.Preoperative TAP block can reduce the amount of analgesic and stress response during operation,and is basically consistent with postoperative TAP block in terms of postoperative analgesic efficacy and accelerated rehabilitation.