Ultrasound-guided OSTAP For Postoperative Analgesia In Gynecological Endoscopic Surgery

Purpose:The safety and efficacy of transverse abdominal muscle plane block(TAPB)combined with intravenous analgesia for postoperative analgesia in patients undergoing gynecological endoscopic surgery have been confirmed in most studies,but the Oblique subcostal transversus abdominis plane block(OSTAP)has been poorly studied.By observing the postoperative analgesic effects of OSTAP and transversus abdominis plane block in the mid-axillary line respectively in patients undergoing gynecological endoscopic surgery,this experiment aimed to find a better postoperative analgesic solution for patients undergoing gynecological endoscopic surgery in order to reduce the length of hospital stay,decrease surgical complications,reduce postoperative pain,reduce the use of opioids,and improve patient satisfaction.Methods:After approval by the medical ethics committee of the hospital,100 patients who underwent gynecological endoscopic surgery(ovarian lesion resection,total hysterectomy and bilateral adnexal resection and uterine fibroids)at Huaihe Hospital of Henan University from December 2020 to October2021 were selected for the study,aged 20 to 55 years,ASA classification I to II,and BMI 18.5 to 23.9kg/m2.One hundred patients were randomly divided into group A(oblique subcostal approach group)and group B(mid-axillary approach group)using the number table method,with 50 patients in each group.In both groups,the same preoperative preparation was adopted,and after induction of conventional anesthesia,sevoflurane was inhaled intraoperatively,dexmedetomidine and remifentanil were pumped intravenously,and the depth of anesthesia was adjusted intraoperatively according to BIS.At the end of surgery,patients in group A underwent bilateral OSTAP block(0.4%ropivacaine + dexamethasone5 mg + dexmedetomidine0.5ug/kg+saline=50ml,25 ml on each side),and patients in group B underwent bilateral mid-axillary line access transversus abdominis plane block(0.4%ropivacaine+dexamethasone5mg+dexmedetomidine0.5ug/kg=50ml,25 ml on each side),and an intravenous electronic analgesic pump(bupropionol tartrate8mg+saline=100 ml)was connected postoperatively.Heart rate and mean arterial pressure before surgery;heart rate and mean arterial pressure after removal of the mask;type of surgery;static and dynamic VAS scores(Visual analogue score(VAS))at 2h(T1),4h(T2),12h(T3),24h(T4)and 48h(T5)after surgery;blocking plane after TAP block in the two groups;length of operation;postoperative patient satisfaction;number of postoperative analgesic remedies;adverse drug reactions such as hematoma at the puncture site,pain at the injection site and infection;adverse drug reactions such as dizziness,nausea and vomiting and serious complications.The length of nerve block operation;postoperative patient satisfaction;number of postoperative analgesic remedies;adverse puncture reactions such as hematoma at the puncture site,pain at the injection site and infection;adverse drug reactions such as dizziness,nausea and vomiting and serious complications.Results:In total,data from 100 patients were included for analysis.The results of the study showed that.1.comparison of vital signs between the two groups of patients.(1)No statistically significant comparison of preoperative heart rate and mean arterial pressure between the two groups of patients(P>0.05).(2)After removal of the laryngeal mask,there was no statistically significant comparison between the heart rate of patients in group A and patients in group B(P>0.05);the mean arterial pressure of patients in group A was lower than that of patients in group B,which was statistically significant(P< 0.05).2.Comparison of pain scores(VAS scores).In the static and dynamic VAS scores of patients at 48 h,there was no statistically significant difference between group A at T1,T2 and T3 time points compared with group B(P>0.05);the VAS scores of group A at T4 and T5 time points were reduced compared with group B,and the difference was statistically significant(P<0.05).3.Comparison of operation time: the operation time of nerve block was longer in group A than in group B.The difference was statistically significant(P<0.05).4.Comparison of block planes: patients in group A had more advantages in T6,T7,T8 and T9 block planes than group B.The difference was statistically significant(P<0.05).5.The overall satisfaction of patients in group A was higher than that in group B.The difference was statistically significant(P<0.05).Conclusions:The results of this study showed that both approaches of transversus abdominis plane block combined with intravenous analgesia provided effective postoperative analgesia for 48 h after gynecologic laparoscopy,and both groups did not experience acute pain after surgery,and after 24 h,the oblique subcostal approach with transversus abdominis plane block was more effective than the mid-axillary approach.The oblique subcostal approach had a higher block plane than the axillary midline approach,and the overall patient satisfaction was higher in the oblique subcostal approach group than in the axillary midline approach group,but the operation time was longer.