Effects Of Different Anesthesia Methods On The Recovery Of Day Operation After Procedure For Prolapse And Hemorrhoids

ObjectiveThis paper compared the anesthetic effect and adverse reactions of three different anesthesia methods in adult daytime prolapse and hemorrhoids mucosal ring anastomosis（PPH）,in order to explore the optimal anesthesia method,so as to promote the rapid recovery of patients.MethodsMethods from July 2019 to January 2020,60 patients scheduled for PPH in the First Affiliated Hospital of Guangzhou Medical University were selected.They were randomly divided into combined spinal epidural anesthesia group（group A）,muscle relaxant laryngeal mask airway general anesthesia+perianal block group（group B）,and no muscle relaxant laryngeal mask airway general anesthesia+perianal block group（Group C）,20 cases in each group.Combined spinal epidural anesthesia group（group A）:combined spinal epidural puncture was performed at the puncture site L_3-4or L_2-3,and subarachnoid injection of 0.5%ropivacaine 2.5ml was given,epidural catheter was retained,and 0.5%ropivacaine was added according to the situation during the operation.Group B received general anesthesia with laryngeal mask airway with muscle relaxant and perianal block:anesthesia induction drugs sufentanil,propofol and cisatracurium were given to maintain anesthesia with propofol and remifentanil.Sufentanil and cisatracurium were not added during operation.Vital signs of patients were closely monitored and drug infusion volume was adjusted according to their own conditions.The patients who finished the operation were given 0.5%ropivacaine 15ml perianal local infiltration for postoperative analgesia.In group C,the patients were given general anesthesia without muscle release laryngeal mask ventilation plus perianal block:sufentanil and propofol were anesthetized and maintained by propofol and remifentanil,and the vital signs of patients were monitored closely and the drug infusion was adjusted according to the patients’own conditions.The patients who finished the operation were given 0.5%ropivacaine15ml perianal local infiltration for postoperative analgesia.Records（1）Gender,age and BMI of the three groups;（2）Anesthesia effect:SBP,DBP,HR and SpO2 were recorded before operation（T0）,at the end of anesthesia（T1）,at the beginning of operation（T2）,at the end of operation（T4）,The incidence of traction reaction,operation time and time of pulling out laryngeal mask;（3）Satisfaction of perianal relaxation during operation;（4）The total dosage of propofol,Sufen and remifentanil was used from induction to end of anesthesia;（5）Pain score:visual analogue scale（VAS）was used to evaluate the pain at 2,6,12 and 24 hours after the operation,Use of analgesics after returning to the ward.（6）the incidence of postoperative urinary retention,chills and other adverse reactions were recorded;（7）The sleep quality of the night after operation was recorded;（8）The length of hospital stay was recorded.Results（1）There were no significant differences in gender,age and BMI among the groups（P>0.05）.（2）Anesthetic effect:the anesthetic effect of group B was significantly better than that of group A and group C.There was no significant difference in vital signs between groups before operation（T0）（P>0.05）;From T1 to T4,the change trend of vital signs in the three groups was basically the same,but SBP,DPB and HR in the three groups from T1 to T3 were statistically significant（P<0.05）,At T3 time point,there were 4 cases of traction reaction in group A,showing sinus bradycardia;（3）The operation time of group B was the shortest,group A was the second,and group C was the longest.There was statistical significance among the three groups（P<0.05）;（4）The time of pulling out LMA in group B was significantly faster than that in group C,and there was statistical significance between the two groups（P<0.05）.（5）The satisfaction rate of perianal relaxation was the highest in group B,followed by group A and the worst in group C,There was significant difference among the three groups（P<0.05）.The dosage of propofol and remifentanil in group B was statistically significant compared with that in group C（P<0.05）,but the dosage of sufentanil in group B and group C was not statistically significant（P<0.05）.（6）The pain in group A was significantly heavier than that in group B and group C at 6h,12h and 24h after operation,There were significant differences between group A and group B or between group A and group C（P<0.05）.There was no significant difference in postoperative pain between group B and group C（P>0.05）.（7）The use rate of postoperative analgesics was the highest in group A,followed by group C,and no analgesics was used in group B.the difference among the three groups was statistically significant（P<0.05）.（8）There was no adverse reaction in group B,The incidence of urinary retention in group A was 40%,10%in group C,there was significant difference among the three groups（P<0.05）.The incidence of shivering was 15%in group A and 20%in group C.There was no significant difference among the three groups（P>0.05）.The traction reaction was 20%in group A,but not in group B and C,there was significant difference among the three groups（P<0.05）.（9）There were more"good"sleep quality in group B than in group A（15%）and group C（14%）,there was significant difference among the three groups（P<0.05）.（10）Patients in group A had the longest hospital stay,while patients in group B were discharged within 24 hours,there was significant difference among the three groups（P<0.05）.ConclusionsAccording to the results of the study,the muscle relaxant laryngeal mask airway ventilation and general anesthesia plus perianal block are more suitable for PPH day surgery.The effect is excellent,the pain degree of patients is reduced effectively,the incidence of urinary retention is significantly reduced,and the patients recover quickly after surgery.It is worth popularizing this anesthesia method and is more suitable for adult PPH.