Postoperative analgesic effect and impact on immune function of ultrasound guided transversus abdominis plane block used in elderly patients after laparoscopic radical resection of rectal cancer / 中国内镜杂志

ABSTRACT

Objective To observe the effect of ultrasound guided transversus abdominis plane block used in laparoscopic radical resection of rectal cancer in elderly patients on postoperative analgesic and impact on immune function. Methods Sixty cases need laparoscopic radical resection of rectal cancer in elderly patients with admission order number to take the digital randomized method was divided into abdominal transverse muscle block group and saline control group. The transversus abdominis plane block group underwent ultrasound guided transversus abdominis plane block after induction of general anesthesia while accepted intravenous injection of 0.25%ropivacaine hydrochloride of 30 ml; Saline control group took equal volume intravenous saline. After operation all were given analgesia pump Sufentanil 1.00 μg/kg + Ondansetron 16.00 mg + Dezocine 10.00 mg + saline to configure for 100 ml, and set 2 ml/h and 15 min of automatic control time. To observe visual analogue score (VAS) and related indexes of hemodynamics before anesthesia (T0), 1 h after operation (T1), 12 h after operation (T2), 24 h after operation (T3) and 48 h after operation (T4) between two groups; Record 24 h analgesia pressing times and total postoperative Sufentanil; And take venous blood to measure CD4+%, CD8+% level by flow cytometry and determinate interferon gamma (IFN-γ) by enzyme-linked immunosorbent assay; Then compare postoperative adverse reactions of two groups. Results Compared with saline control group,transversus abdominis plane block group' MAP decreased in T1, T2, and HR decreased in T2 and T3 (P < 0.05). Transversus abdominis plane block groups' MAP in T1 was higher than T0, and HR in T1, T2 was higher than that of T0 (P < 0.05). Compared with saline control group, transversus abdominis plane block group' VAS scores were lower at the T1, T2, T3, T4, else postoperative 24 h pressing times and amount of Sufentanil were decreased (P < 0.05). Compared with saline control group, transversus abdominis plane block group' CD4+% levels increased in T1, T2, T3 and T4, IFN-γ levels in T2, T3 points were higher (P < 0.05). Compared with the saline control group, transversus abdominis plane block group' rate of adverse reactions was lower (P < 0.05). Conclusion Ultrasound guided transversus abdominis plane block used in laparoscopic radical resection of rectal cancer in elderly patients has better postoperative analgesic effect, stable hemodynamics and less postoperative pain, and it has protective effect on immune function and lower incidence of adverse reactions, so clinical application is safety.