Application Of Ultrasound-guided Based On The Surgical Incision Side Transverse Abdominis Muscle Plane Combined With Rectus Sheath Block Based On Surgical Incision Side In Kidney Transplantation

Objective Patients often suffer from moderate to severe pain after kidney transplantation（KT）.Studies have shown that both transverse abdominis plane block and rectus sheath block can effectively relieve acute postoperative pain.Therefore,this study observed whether the combined of these two methods had any differences in the effects of postoperative pain and sleep quality in patients undergoing KT.Methods1.Study objects and groups: A total of 40 patients who were selected for KT in our hospital were randomly divided into Group N（The surgical incision side of general anesthesia plus TAPB and RSB,n=20）and Group C（general anesthesia alone,n=20）.2.Anesthetic method: Both groups of patients received total intravenous general anesthesia.in Group N the RSB was performed based on the incision,a mixture of0.4% ropivacaine + 0.6μg/kg dexmedetomidine total 15 ml was injected under ultrasound visualization.Then the TAPB was performed with a mixture of 0.4%ropivacaine + 0.6 μg/kg dexmedetomidine total of 15 ml on the same side.Patients in group C were also given normal saline with the same volume as those in group N before the surgical incision side induction of general anesthesia.3.Outcome measures:3.1 Primary outcome measures: The patient’s first compression time of the intravenous analgesic pump within 24 hours after surgery,the operative consumption of remifentanil.3.2 Secondary outcome measures: The patient’s resting and cough pain score（Numerical rating scale,NRS）within 72 hours after surgery,and the patient’s sleep quality score within three days after surgery（Campbell Sleep Scale,Richards-Campbell Sleep Questionnaire,RCSQ）.The number of compressions and effective compressions of the intravenous analgesia pump within 72 hours after surgery.Postoperative rescue analgesic use in patients.The consumption of propofol,sufentanil,the duration of anesthesia and operation,the time to remove the tracheal tube,and the time to stay in the anesthesia recovery room after surgery.The incidence of delirium after surgery was recorded.Results There was no statistical difference between the two groups in general data such as gender,age,weight,American Society of Anesthesiologists classification,and cardiac function classification.Primary outcome measures: The operative consumption of remifentanil[0.0,157.5 g] was significantly lower than that of remifentanil [1560.3,2379.0 g],which was statistically significant（P <0.05）.The first pressing time of the analgesic pump after surgery in group N was significantly longer than that in group C（P<0.05）.Secondary outcome measures: The pain scores during resting and coughing within 0-6h,6-12 h,12-24 h after surgery in group N were lower than those in group C（P <0.05）.Twenty-four to 48 hours after surgery,the cough pain score of patients in group N was significantly lower than that in group C（P<0.05）,and there was no statistical significance between the two groups at rest.There was no statistical significance in the pain scores at rest and cough within 48-72 hours after surgery.The scores of sleep quality on the first night after surgery in group N was significantly higher those that in group C（P<0.05）.There was no significant difference between the two groups of patients in the total number of analgesic pump compressions and the effective number of compressions within 72 hours after surgery.There was no statistical significance in the consumption of rescue analgesics within 24 hours after surgery between the two groups of patients.The consumption of rescue analgesics in group N was lower than that in group C within 24 to 48 hours after surgery,the total postoperative rescue analgesic consumption in group N was significantly lower than that in group C（P<0.05）.There was no significant difference in the duration of operation and anesthesia,consumption of propofol and sufentanil,postoperative tracheal catheter removal time,postoperative retention time in the recovery room,and the incidence of postoperative delirium between the two groupsConclusion For patients undergoing elective KT surgery,TAPB combined with RSB based on the incision side can significantly reduce the amount of remifentanil used during surgery,prolong the time of the first postoperative analgesic pump pressure,reduce the pain score of resting and coughing within 24 hours after surgery,and improve the sleep quality of patients on the first night after surgery.