Objective: To explore the effect of opioid-free anesthesia (OFA) combined with quadratus lumborum block (QLB) in laparoscopic radical colorectal cancer resection.
Methods: Sventy patients were selected for undergoing laparoscopic radical colorectal cancer resection from March to December 2023, 49 males and 21 females, aged 18-75 years, BMl 18.5-28.0 kg/m2, ASA physical status Ⅱ or Ⅲ. The patients were divided into two groups using random number table method: the OFA group (group OFA) and the conventional opioid anesthesia group (group OA), 35 patients in each group. Group OFA underwent bilateral posterior QLB under ultrasound guidance before anesthesia induction (0.25% ropivacaine 30 ml on each side), and anesthesia induction and maintenance were performed using opioid-free anesthesia regimen. And group OA cannot undergo QLB, and anesthesia induction and maintenance were carried out using opioid containing regimen. The patient's HR and MAP were recorded before anesthesia induction (T0), 1 minute after endotracheal intubation (T1), before pneumoperitoneum establishment (T2), 1 minute after pneumoperitoneum establishment (T3), 1 hour after surgery (T4), the end of surgery (T5), and leaving the operating room (T6). The time from the patient's anesthetic discontinuation to extubation, the length of stay in the PACU, and the Steward and VAS pain scores when the patient leaves the operating room, which were recorded. NRS scores at rest and in the motor state 6, 12, 24, and 48 hours after surgery, time to first exhaust, time to first ambulation, and length of postoperative hospital stay, effective PCIA pressing times and use of additional analgesic drugs within 48 hours after the operation, and postoperative adverse reactions (nausea, vomiting, hallucinations) were also recorded.
Results: Compared with T0, the MAP of the two groups decreased significantly at T1, T2, T4, and T5(P < 0.05), the HR in group OFA increased significantly at T1 and slowed down at T4 and T5(P < 0.05), and the HR in group OA decreased significantly at T1-T5(P < 0.05). Compared with group OA, the HR in group OFA increased significantly at T1-T3, and the MAP increased significantly at T1(P < 0.05). Compared with group OA, the extubation time and PACU residence time were significantly delayed (P < 0.05), and the Steward score when leaving the operating room was significantly lower in group OFA (P < 0.05). Compared with group OA, NRS score was significantly deceased 6, 12, 24, and 48 hours after the surgery (P < 0.05), time to first exhaust, time to first ambulation, and length of postoperative hospital stay were significantly shartened (P < 0.05), and effective PCIA pressing times and additional analgesia times were significantly decreased (P < 0.05), incidence of intraoperative hypotensionand postoperative nausea and vomiting (P < 0.05).
Conclusion: OFA combined with QLB can safely and effectively complete laparoscopic radical colorectal cancer surgery. Patients with such anesthetic methods are hemodynamically more stable during anesthesia induction and intraoperatively. These patients have better postoperative analgesia and less need for additional analgesics, and less incidence of postoperative nausea and vomiting. This approach is more beneficial for the recovery of the patient's gastrointestinal function. |
