Application Of Ropivacaine At Different Concentrations In Transverse Abdominis Plane Block Combined With Rectus Abdominis Shrath Block In Postoperative Analaesia Of Appendectomy

Objective To analyze the analgesic effect of different concentrations of ropivacaine under general anesthesia for ultrasound-guided transversal muscle block combined with rectus sheath block after laparoscopic appendectomy.Methods 120 patients undergoing laparoscopic appendectomy in Affiliated Hospital of Yanbian University were randomly divided into A,B,C and D groups,with 30 patients in each group.The subjects were general anesthesia group alone.General anesthesia combined with left transverse muscle plane block combined with bilateral rectus sheath block,ropivacaine concentrations of 0.2%,0.35%and 0.45%.All the patients were induced by general anesthesia with the same standard anesthesia.After induction,ultrasound-guided left transverse muscle plane block combined with bilateral rectus sheath block were performed,and the skin was opened 20 minutes later.A one-time Patient Controlled Intravenous Analgesia(PCIA)analgesia pump(sufentanil 100ug+Azasetron 10mg to 100ml)was applied after the operation.Background dose;2ml/h,single dose:0.5ml,locking time:15min.The Ramsay scores,Bruggrmann Comfort Scale(BCS)and Visual Analog Scale(VAS)of the four groups were evaluated respectively at 2h(T0),6h(T1),12h(T2)and 24h(T3)after surgery.The time and times of the first pressure on the analgesia pump were observed.PCIA complications(nausea,vomiting,dizziness,sweating,itching,hypotension,etc.)occurred in each group.Complications associated with Transverse Abdominis Plane Block(TAPB)combined and Rectus Sheath Block(RSB)(local infection,local hematoma,nerve injury,local anesthetic into the vessel,local anesthetic poisoning,etc.)occurred.Results(1)Ramsay score at each postoperative time point:Compared with group A,group B,C and D were all increased,the difference was statistically significant(P<0.05);Group D had the highest sedation,followed by group C,and group B had the lowest,the difference was statistically significant(P<0.05),indicating that group D had the best sedation effect and the highest patient satisfaction.(2)VAS scores at each time point after surgery:compared with group A,VAS scores in group B,C and D were all decreased,the difference was statistically significant(P<0.05).At T0,group D was the lowest,followed by group C,and group B was the highest,the difference was statistically significant(P<0.05).At T1,group C and D were lower than group B,the difference was statistically significant(P<0.05).At T2,group B and Group D were lower than group C,the difference was statistically significant(P<0.05),indicating that group D had the best analgesic effect.(3)Postoperative BCS score at each time point:compared with group A,the BCS score in group B,C and D increased at T0,T1 and T3,and in group C and D at T2,the difference was statistically significant(P<0.05).At each time point,both group C and Group D were higher than group B(P<0.05).At T0 and T2,group D was higher than group C,the difference was statistically significant(P<0.05),indicating that group D had the lowest pain sensation and the highest comfort level.(4)Time and times of the first pressure on the analgesia pump:compared with group A,the time of the first pressure on the analgesia pump in group B,C and D was longer,the difference was statistically significant(P<0.05);Compared with group B and C,group D took the longest time to press analgesia pump for the first time,the difference was statistically significant(P<0.05).Compared with group A,The Times of pressing were reduced in group B,C and D,the difference was statistically significant(P<0.05).Compared with group B and C,group D had the least number of presses,the difference was statistically significant(P<0.05),indicating that TAPB combined with RSB under general anesthesia had a better analgesic effect compared with general anesthesia alone,and the concentration was higher,the analgesic effect was better.(5)PCIA related complications:Compared with group A,the incidence of nausea,vomiting,sweating,pruritus and dizziness was reduced in group B,C and D,the difference was statistically significant(P<0.05),indicating that when the amount of postoperative analgesics was reduced,the corresponding complications would also be reduced.(6)No TAPB combined RSB related complications occurred in all patients(local anesthetics went into blood vessels accidentally,local anesthetics poisoning,infection bleeding,puncture of peritoneum into abdominal cavity,and severe abdominal wall injury)Conclusion(1)In laparoscopic appendectomy,TAPB combined with RSB under general anesthesia has a better postoperative analgesic effect than under general anesthesia alone.(2)0.45%ropivacaine has better analgesic effect in TAPB combined with RSB under general anesthesia,less postoperative complications and more safety.