Effects Of Esketamine-Ropivacaine Multi-mode Analgesia On Postoperative Pain And Early Recovery In Laparoscopic Gynecological Surgery

ObjectiveTo evaluate the effects of esketamine-ropivacaine on the analgesic and early recovery after gynecological laparoscopic surgery.Materials and Methods50 patients underwent elective laparoscopic surgery due to the benign gynecological diseases(uterine fibroids,endometrial dysplasia,endometriosis,adnexal cyst,etc.).Randomized double-blind into ropivacaine group(L group)and esketamine + ropivacaine group(M group),both group conventional endotracheal intubation after intravenous induction general anesthesia,group L analgesia regimen is preoperative injection of saline and postoperative 0.4% ropivacaine incision local infiltration,group M analgesia regimen for preoperative esketamine 0.15 mg / kg and postoperative 0.4% ropivacaine incision local infiltration.Patient age,height,weight,body mass index BMI,history of abdominal surgery,anesthesia time,operation time,extubation time,intraoperative blood loss,and 2 h after surgery were recorded,6 h,12 h and 24 h(visual analogue scales,VAS score),number of salvage analgesia,postoperative sufentanyl use,incidence of nausea and vomiting,and 40 recovery quality scores at 24 h after surgery(quality of Recovery-40 score,QoR-40 score),postoperative ambulation,catheter removal,first exhaust,first food intake,postoperative hospitalization and incidence of adverse reactions including dizziness,drowsiness,itching,respiratory depression,and fever.Results1.General situation: The age,height,weight,BMI and history of abdominal surgery between the two groups(P> 0.05).2.Surgical status: There was no significant difference between anesthesia time,surgery time,extubation time,and intraoperative bleeding volume between the two groups(P> 0.05).3.Postoperative VAS score: Comparison between the two groups: the VAS scores at 2 h,6 h,12 h and 24 h,and the differences were statistically significant(P<0.05).Comparison between the two patient groups: compared with L group,postoperative VAS scores at 2 h and 6 h were significantly reduced,statistically significant(P <0.05),and no significant difference between VAS scores at 12 h and 24h(P> 0.05).4.Postoperative salvage analgesia and incidence of nausea and vomiting: There was no significant difference in salvage analgesia rate between groups L and M(P>0.05).There was no significant difference in sufentanil use and the incidence of nausea and vomiting between groups L and M(P> 0.05).5.QoR-40 score: There was no significant difference between the QoR-40 scores at 24 h after surgery(P> 0.05).When the five aspects were analyzed separately,there was no significant difference between the physical comfort,emotional state,self-care ability,psychological support and pain perception between the two groups(P> 0.05).6.Postoperative recovery: The difference was significant between the two groups(P <0.05),and there was no difference between the time to catheter removal,first discharge,and postoperative hospital stay in the two groups(P> 0.05).7.Incidence of adverse reactions: Three patients in Group L experienced dizziness,three patients in Group M,and one patient had fever,without a significant difference between the overall incidence of adverse effects between the two groups(P> 0.05).ConclusionUnder the multimodal analgesic intervention of accelerated rehabilitation surgery,preoperative intravenous injection of 0.15 mg/kg esketamine combined with postoperative incision local infiltration of 0.4% ropivacaine 20 ml reduced the VAS score at 2 h and 6 h after gynecological laparoscopy,with early mobilization without serious adverse reactions.