Application of transversus abdominis plane block combined with rectus sheath block in patients undergoing laparoscopic total hysterectomy / 中国医师进修杂志

ABSTRACT

Objective:To evaluate the effect of total intravenous anesthesia combined with transversus abdominis plane block (TAPB) and rectus sheath block (RSB) in patients undergoing laparoscopic total hysterectomy.Methods:One hundred and twenty patients who required a laparoscopic total hysterectomy under total intravenous anesthesia from April 2019 to June 2020 in General Hospital of Eastern Theater Command were selected. The patients were divided into 4 groups by random digits table method with 30 cases each total intravenous anesthesia group (C group), total intravenous anesthesia combined with TAPB group (T group), total intravenous anesthesia combined with RSB group (R group) and total intravenous anesthesia combined with TAPB and RSB group (S group). The narcotic (propfol and remifentanil) dosage, changes of resting visual analogue score (VAS) within 48 h after operation, pressure number of analgesia pump within 48 h after operation, anesthesia satisfaction score and incidence of emergence agitation were compared among 4 groups.Results:The remifentanil dosage, propfol dosage and pressure number of analgesia pump within 48 h after operation in S group were significantly lower than those in T group, R group and C group (1.09 ± 0.23) mg vs. (1.49 ± 0.21), (1.47 ± 0.26) and (1.48 ± 0.23) mg, (543.53 ± 41.78) mg vs. (618.96 ± 37.21), (598.67 ± 37.86) and (607.87 ± 36.93) mg, (3.52 ± 2.03) times vs. (5.47 ± 1.83), (6.63 ± 2.08) and (9.77 ± 2.16) times, the anesthesia satisfaction score was significantly higher than that in R group and C group (18.13 ± 3.22) scores vs. (21.43 ± 2.42) and (21.44 ± 2.56) scores, and there were statistical differences ( P<0.05). The resting VAS extubation and 12, 24, 48 h after operation in S group was significantly lower than that in C group and R group, the resting VAS 12, 24 and 48 h after operation was significantly lower than that in T group, and there were statistical differences ( P<0.05). The incidence of emergence agitation in S group was significantly lower than that in C group 6.67% (2/30) vs. 26.67% (8/30), and there was statistical difference ( P<0.05). Conclusions:TAPB combined with RSB can reduce the narcotic dosage, reduce the incidence of emergence agitation and relieve perioperative pain in patients undergoing laparoscopic total hysterectomy. The effect is better than that of total intravenous anesthesia and total intravenous anesthesia combined with TAPB or RSB.