| Objective:Comparing the effect between retrolaminar block and local infiltration analgesia for postoperative analgesia on elective retroperitoneal laparoscopic nephrectomy,and evaluating the safety and effectiveness of retrolaminar block.Methods:1.This study was a prospective,randomized,double-blind control study.120 patients who underwent elective posterior laparoscopic nephrectomy in Zunyi Medical University Affiliated Hospital were collected as research objects.They were randomly divided into retrolaminar block group?Group-RLB?and local infiltration analgesia group?Group-LIA?.The same scheme was adopted for anesthesia induction and maintenance in the two groups,patients in Group-RLB were performed retrolaminar block after general anesthesia induction,patients in Group-LIA were performed local infiltration analgesia before surgery suture completion.2.With formal inclusion as a starting point,monitoring and recording according to the following indicators:?1?Baseline data:Demographic information of patient age,gender,height,weight,ethnicity,etc.General condition before operation including ASA classification,hemodynamics,blood gas analysis,etc.Anesthesia and surgical information such as diagnosis,anesthesia time,block operation time,operation time,surgical side position,operative incision size,etc.?2?Safety index:patients'mortality,incidence of block-related complications.Hemodynamic changes at various observation time points during surgery and resuscitation,blood gas analysis results 30 minutes after extubation.Hospitalization informarions such as patient's total hospitalization time,postoperative hospitalization time,total hospitalization expenses,etc.?3?Effectiveness index:At each observation time,Analgesic information such as postoperative VAS score,sufentanil consumption,number of PCIA compressions,situation of patients had additional analgesics and PCIA exhaustion in advance.Resuscitation time such as withdrawal anesthesia-extubation time,extubation-extraction PACU time,PACU stay time and the first bed-out time after operation.Use of intravenous anesthesia drugs and vasoactive drugs during the operation.Contents of?-EP,IL-1?and PGE2 in pain and inflammation related factors after extubation for 30 minutes.after surgery.3.The patient gender,whether the incision is prolonged,and the surgical side position,were defined as stratified factors,and stratified analysis was performed.Results:1.120 patients were included in the initial screening,5 cases were excluded for the reasons:The blood pressure of two patients increased to 200/100mmHg after entering the operating theatre,the anesthesiologist and the surgeon decided to suspend the operation with consensus;three patients had hemorrhagic shock due to more intraoperative bleeding and were unable to extubate after surgery,and they were sent to intensive care unit for observation and treatment.Finally 115 patients were included in the study for data processing and analysis,including 57 in Group-RLB and 58 in Group-LIA.2.Baseline dataThere was no statistical difference between the two groups in demographic information,ASA classification,hemodynamics,blood gas analysis,diagnosis,anesthesia time,operation time,surgical side position,incision size and other anesthesia and surgery information?P>0.05?;compared with the time of block operation,Group-RLB was longer than Group-LIA?P<0.05?.3.Safety index?1?Comparing the mortality rate,the number of patients in both groups was zero;comparing the incidence of postoperative nausea/vomiting,Group-RLB was lower than Group-LIA?P<0.05?;compareing the incidence of postoperative excessive sedation,there was no statistical difference between Group-RLB and Group-LIA?P<0.05?.Other block related complications,the number of cases in both groups was zero.?2?Blood gas analysis after extubation for 30 minutes:at natrium,kalium,calcium,lactic,hemoglobin,the difference between the two groups was not statistically significant?P>0.05?;Group-RLB had significantly lower blood glucose than Group-LIA?P<0.05?.?3?HR:at the time when 10 minutes after Group I anesthesiologist evacuation,immediately after extubation,after extubation for 20 minutes,after extubation for 30 minutes,Group-RLB was significantly lower than Group-LIA?P<0.05?.MAP:at the time when 10minutes after Group I anesthesiologist evacuation,immediately after extubation,after extubation for 10 minutes,after extubation for 20 minutes,after extubation for 30 minutes,Group-RLB was significantly lower than Group-LIA?P<0.05?.SpO2:at each observation time point,the difference between the two groups was not statistically significant?P>0.05?.?4?Total hospital stay,postoperative hospital stay,and total hospital cost,the difference between the two groups was not statistically significant?P>0.05?.4.Effectiveness index?1?Postoperative VAS scores:at the time when 6 hours after surgery,24 hours after surgery,48 hours after surgery,Group-RLB was statistically lower than Group-LIA?P<0.05?.Postoperative sufentanil consumption,at the time when 6 hours after surgery,24 hours after surgery,48 hours after surgery,Group-RLB was obviously less than Group-LIA?P<0.05?.The number of postoperative PCIA compressions,at the time when 24 hours after surgery,48 hours after surgery,Group-RLB was obviously less than Group-LIA?P<0.05?.?2?Analepsia time and the first time to leave bed:the anesthetic withdrawal-extubation time,the extubation-PACU departure time,the PACU retention time,the first time to leave bed of Group-RLB was obviously earlier than that of Group-LIA?P<0.05?.?3?Use of intraoperative drugs:there was no statistically difference in the consumption of propofol and rocuronium between the two groups?P>0.05?;the consumption of remifentanil in Group-RLB was obviously less than that in Group-LIA?P<0.05?;number of patients used ephedrine during surgery,there was no statistically difference between the two groups;no patients in both groups received norepinephrine.?4?Pain and inflammatory related factors at 30 minutes after extubation:Group-RLB had obviously lower?-EP,IL-1?,PGE2 than Group-LIA?P<0.001?.?5?Postoperative patients with additional analgesics:at the time when 6 hours after surgery,12 hours after surgery,24 hours after surgery,48 hours after surgery,Group-RLB was less than Group-LIA?P<0.05?.The patient number of premature depletion of PCIA after surgery,Group-RLB was significantly less than Group-LIA?P<0.05?.5.Stratified analysis?1?GenderPostoperative VAS score:male patients at the time when 24 and 48 hours after surgery,Group-RLB was lower than Group-LIA?P<0.05?;female patients at the time when 2,4,6,24 and 48 hours after surgery,Group-RLB was lower than Group-LIA?P<0.05?.Postoperative sufentanil consumption:male patients at the time when 24 hours after surgery,Group-RLB was less than Group-LIA?P<0.05?;female patients at the time when 24 and 48hours after surgery,Group-RLB was less than Group-LIA?P<0.05?.The number of postoperative PCIA compressions:male patients at the time when 24 and 48 hours after surgery,Group-RLB was less than Group-LIA?P<0.05?;female patients at the time when 2,4,6,24 and 48 hours after surgery,Group-RLB was less than Group-LIA?P<0.05?.Analepsia time and the first time to leave bed:for male patients,the anesthetic withdrawal-extubation time,the extubation-PACU departure time and the first time to leave bed of Group-RLB was earlier than that of Group-LIA?P<0.05?;for female patients,the extubation-PACU departure time,the PACU retention time and the first time to leave bed of Group-RLB was earlier than that of Group-LIA?P<0.05?.Pain and inflammatory related factors at 30 minutes after extubation:for male patients,Group-RLB had lower PGE2 than Group-LIA;for female patients,Group-RLB had lower PGE2 and IL-1?than Group-LIA?P<0.05?.?2?Whether the incision is prolongedPostoperative VAS score:patients with not prolonged incision,at the time when 24 and48 hours after surgery,Group-RLB was lower than Group-LIA?P<0.05?;patients with prolonged incision,at the time when 24 and 48 hours after surgery,Group-RLB was lower than Group-LIA?P<0.05?.Postoperative sufentanil consumption:patients with not prolonged incision,at the time when 4,6,24 and 48 hours after surgery,Group-RLB was less than Group-LIA?P<0.05?.The number of postoperative PCIA compressions:patients with not prolonged incision,at the time when 4,6,24 and 48 hours after surgery,Group-RLB was less than Group-LIA?P<0.05?;patients with prolonged incision,at the time when48 hours after surgery,Group-RLB was less than Group-LIA?P<0.05?.Analepsia time and the first time to leave bed:patients with not prolonged incision,the extubation-PACU departure time,the PACU retention time and the first time to leave bed of Group-RLB was earlier than that of Group-LIA?P<0.05?;patients with prolonged incision,the anesthetic withdrawal-extubation time,the PACU retention time and the first time to leave bed of Group-RLB was earlier than that of Group-LIA?P<0.05?.Pain and inflammatory related factors at 30 minutes after extubation:patients with not prolonged incision,Group-RLB had lower IL-1?and PGE2 than Group-LIA?P<0.05?;patients with prolonged incision,Group-RLB had lower?-EP,IL-1?and PGE2 than Group-LIA?P<0.05?.?3?Surgery left or right lateralPostoperative VAS score:at each observation time point,there was no statistically difference between Group-RLB left side and right side?P>0.05?.Postoperative sufentanil consumption:at the time when 24,48 hours after surgery,Group-RLB left side was more than right side?P<0.05?.The number of postoperative PCIA compressions:at the time when2 hours after surgery,Group-RLB left side was less than right side?P<0.05?.Analepsia time and the first time to leave bed:comparing the anesthetic withdrawal-extubation time,the extubation-PACU departure time,the PACU retention time and the first time to leave bed,there was no statistically difference between Group-RLB left side and right side?P>0.05?.Pain and inflammatory related factors at 30 minutes after extubation:comparing?-EP,IL-1?and PGE2,there was no statistically difference between Group-RLB left side and right side?P>0.05?.Conclusion:1.Postoperative retrolaminar block does not increase patient mortality rate and complications related to regional block,which is safely used for postoperative analgesia on retroperitoneal laparoscopic nephrectomy.2.Postoperative retrolaminar block can reduce the postoperative VAS score of patients,reduce the consumption of analgesic drugs during perioperative period,improve the quality of recovery and rehabilitation,and reduce the levels of pain and inflammation-related factors,which is effect for postoperative analgesia on laparoscopic nephrectomy.3.Retrolaminar block is performed in the chest segments 8,9,and 10,and the analgesic effect is not affected by the left and right sides of the operation and the size of the laparoscopic surgical incision. |
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