Effect Of Ropivacaine Combined With Dexamethasone Or Dexmedetomidine In Transversus Abdominis Plane Block On Analgesic Effect Of Laparoscopic Radical Gastric Cancer Surgery For Middle-Aged And Elderly Patients

Objective To observe the effect of low concentration 0.25%ropivacaine combined with different adjuvant in transversus abdominis plane(TAP)blocks on the opioid use and postoperative pain during laparoscopic gastric cancer radical surgery in middle-aged and elderly patients.Methods A total of 140 patients undergoing elective laparoscopic radical gastrectomy for gastric cancer were selected,aged 55 to 75 years old,grade ASA level 1 to 3,and randomly divided into four groups of 35 patients each.Group A: 0.25% ropivacaine 40 ml combined with dexmedetomidine 0.2ug / kg;Group B: 0.25% ropivacaine 40 ml combined with dexamethasone 10mg;Group C: 0.25% ropivacaine 40ml;R as a control group,20 ml of normal saline was given to each side.MAP was recorded at each time point before TAP block(T0),before pneumoperitoneum(T1),after pneumoperitoneum(T2)and 10 min after tracheal catheter was removed(T3);Intraoperative dosages of propofol and remifentanil were recorded.VAS score at 3h,6h,12 h,24h and 48 h,Ramsay score,and changes in blood glucose at 1h,6h,12 h and 24 h after surgery and preoperative;The frequency of analgesic pump and sufentanil dosage within 24 h after operation;Postoperative adverse reactions,ventilation time,and length of hospital stay.Results There were no significant differences in general information,at any time point in terms of hemodynamics and operation time among the four groups of patients.Compared with the R group,the dosage of propofol and remifentanil in the three groups of ABC was significantly less than that in the R group,but the difference between the three groups of ABC was not statistically significant.Postoperative blood glucose in group B was significantly higher than that in the three ACR groups within12 h after surgery,and there was no significant difference among the three groups at each time point,and there was no significant difference among the four groups at 24 h and before surgery.VAS scores at rest and exercise after surgery were significantly lower in ABC group than in R group at 3h,6h and 12 h after surgery,and there was no significant difference in VAS scores at rest and exercise at 24 h and 48 h,compared with group C,group AB was significantly lower than group C.Postoperative sedation Ramsay score was significantly higher in group A than in group BCR;within 24 hours after operation,sufentanil dosage,the number of analgesia pump compressions and postoperative hospital stay in group R were significantly more than those in group ABC and there was no significant difference between group ABC.Postoperative ventilation time and adverse reactions such as nausea and vomiting were not significantly different between the four groups.Conclusion Ultrasound guided TAP can significantly reduce the dosage of remifentanil during laparoscopic radical gastric cancer surgery in middle-aged and elderly patients,improve the postoperative analgesic effect,and adding adjuvants can improve postoperative analgesic effect,which is beneficial to promote patients quick recovery after surgery.