Objective To explore the effects of transversus abdominis plane block (TAPB) combined with intravenous injection of hydromorphone on the stress response and postoperative analgesia in patients undergoing laparoscopic colorectal cancer surgery.
Methods A total of 119 patients undergoing laparoscopic radical colorectal cancer surgery, 43 males and 76 females, aged 40-64 years, BMI <28 kg/m2, ASA physical status Ⅱ or Ⅲ, were randomly divided into 4 groups: TAPB group (group T, n = 29), hydromorphone group (group H, n = 31), TAPB combined with hydromorphone group (group TH, n = 30), and control group (group C, n = 29). The VAS pain scores and SAS scores were recorded at 5 min, 1 h, 6 h, 12 h, 24 h after extubation. The plasma epinephrine (E) and norepinephrine (NE) concentrations were recorded at 10 min before induction and 5 min after extubation. The use of propofol, remifentanil, atropine, deoxyepinephrine, esmolol and urapidil during the operation were recorded. The effective pressing times of analgesic pump, sufentanil dosage, and the numbers of postoperative remedial analgesia within 24 hours after operation were recorded. The adverse reactions within 24 hours after extubation including nausea and vomiting, hypotension, respiratory depression, and skin itching were also recorded.
Results Compared with 10 min before induction, the plasma E and NE concentrations of four groups were significantly higher at 5 min after extubation (P < 0.05). The plasma E and NE concentrations in groups T, H and TH were significantly lower than those in group C at 5 min after extubation (P < 0.05), and the plasma E and NE concentrations in group TH were significantly lower than those in groups H and T at 5 min after extubation (P < 0.05). VAS and SAS scores in groups T and TH were significantly lower than those in group C at 5 min, 1 h, 6 h after extubation, meanwhile VAS scores in group TH were significantly lower than in groups T and H (P < 0.05). The intraoperative doses of propofol and remifentanil, the use rate of phenylephrine, the effective pressing times of analgesic pump, sufentanil dosage, and the rescue analgesia rate in groups H, T and TH were significantly lower than those in group C (P < 0.05), while these outcomes were significantly lower in group TH than in groups T and H except the rescue analgesia rate (P < 0.05). There were no significant differences in the incidences of nausea and vomiting, respiratory depression, skin pruritus, and constipation among the four groups within 24 hours after extubation.
Conclusion Compared with TAPB or hydromorphone alone, TAPB combined with intravenous administration of hydromorphone can reduce the stress response of patients undergoing laparoscopic colorectal cancer surgery and achieve better early analgesia effects. |
