ABSTRACT
Objective:To compare the effects of transverse abdominis plane block and incision infiltration anesthesia on the early postoperative recovery in the patients undergoing thoracoscopic lung resection with general anesthesia.Methods:Eighty American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients, regardless of gender, aged 50-78 yr, with body mass index of 18-30 kg/m 2, scheduled for elective thoracoscopic lung resection under general anesthesia, were divided into 2 groups ( n=40 each) using a random number table method: incision local infiltration group (group D) and transverse abdominis plane block group (group E). In group E, the patients were changed to the lateral position after completion of anesthesia induction, ultrasound-guided transverse abdominis plane block was performed on the affected side, with 0.25% ropivacaine hydrochloride 30 ml injected. In group D, infiltration anesthesia with 0.25% ropivacaine hydrochloride was performed before incision. Postoperative patient-controlled intravenous analgesia was carried out, and flurbiprofen axetil was intravenously injected for rescue analgesia when the numerical rating scale score at rest >3 or numerical rating scale score≥6 while coughing. Quality of Recovery-15 scale scores were assessed at 1 day before surgery and 24 and 48 h after surgery. Plasma concentrations of interleukin-6 (IL-6) and IL-1β were measured by enzyme-linked immunosorbent assay before incision, at the end of surgery, and at 24 h after surgery. The amount of remifentanil used during surgery, the number of effective pressing times of patient-controlled analgesia within 48 h after surgery, requirement for rescue analgesia, first ambulation time after surgery, time to first flatus, length of hospital stay, and occurrence of nausea and vomiting and pulmonary infection within 48 h after surgery were recorded. Results:Compared with group D, Quality of Recovery-15 scale scores were significantly increased, the amount of remifentanil used during surgery and the number of effective pressing times of patient-controlled analgesia were reduced, the rate of rescue analgesia was decreased, the time to first rescue analgesia was prolonged, and the time to first flatus was shortened in group E ( P<0.05). There were no significant differences in the plasma concentrations of IL-6 and IL-1β at various time points, time to first ambulation after surgery, length of hospital stay, and incidence of nausea and vomiting and pulmonary infection between the two groups ( P>0.05). Conclusions:Compared with incision infiltration anesthesia, transverse abdominis plane block can reduce intraoperative consumption of opioids, alleviate postoperative pain, and promote early postoperative recovery when used for thoracoscopic lung resection under general anesthesia.
ABSTRACT
Objective To investigate the change in the function of the motor nerve fibers of the sciatic nerve of rat following injection of different neurolytic drugs. Methods Thirty-five SD rats weighing 350-380 g were randomly divided into 7 groups ( n = 5 each): group C received normal saline; group Ad adriamycin 5 mg/ml;group Aa anhydrous alcohol; group Pg1 8% phenol-glycerol; group Pg2 10% phenol-glycerol; group Pg3 12% phenol-glycerol and group Ci cidomycin 4000 U/ml. 0.2 ml of the different neurolytic drugs was injected at the points where the branches of the sciatic nerve entering semi-membranous and adductor magnus muscles. The action potential and conduction velocity of motor and sensory nerve fibers were measured at 21 d after injection. Results The conduction velocity of sensory nerve fibers was 0 in each group. The conduction velocity and action potential of the motor nerve fibers were significantly decreased in group Ad, Aa, Pg1, Pg2, Pg3 and Ci as compared with group C (the control group). The action potential and the conduction velocity were significantly higher in group Ad than in other neurolytic drug groups. The potential and the conduction velocity were the lowest in group Aa and Pg3.The conduction velocity in group Pg1, Pg2, Ci was comparable. Conclusion 5% adriamycin seems to be a better neurolytic drug with less interference with function of motor never fibers.