Laparoscopic surgery is the main treatment method for patients with gastrointestinal malignant tumors.Although laparoscopic surgery is minimally invasive,its tool stimulation and pneumoperitoneum pressure often cause ...Laparoscopic surgery is the main treatment method for patients with gastrointestinal malignant tumors.Although laparoscopic surgery is minimally invasive,its tool stimulation and pneumoperitoneum pressure often cause strong stress reactions in patients.On the other hand,gastrointestinal surgery can cause stronger pain in patients,compared to other surgeries.Transversus abdominis plane block(TAPB)can effectively inhibit the transmission of nerve impulses caused by surgical stimulation,alleviate patient pain,and thus alleviate stress reactions.Remazolam is an acting,safe,and effective sedative,which has little effect on hemodynamics and is suitable for most patients.TAPB combined with remazolam can reduce the dosage of total anesthetic drugs,reduce adverse reactions,reduce stress reactions,and facilitate the rapid postoperative recovery of patients.展开更多
BACKGROUND Transversus abdominis plane block(TAPB)is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle achieved with local anesthetics.It can effect...BACKGROUND Transversus abdominis plane block(TAPB)is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle achieved with local anesthetics.It can effectively block the conduction of the anterior nerve of the abdominal wall and exert a good analgesic effect.However,the effect of combining the block with remimazolam on anesthesia in patients undergoing gastrointestinal tumor surgery is still unclear.AIM To examine the effects of combining TAPB with remimazolam on the stress response and postoperative recovery of gastrointestinal tumor surgery patients.METHODS A retrospective analysis was conducted on the clinical data of 102 individuals diagnosed with gastrointestinal malignancies who underwent laparoscopic surgery under general anesthesia between April 2020 and June 2023.The patients were categorized into a control group(n=51),receiving remimazolam for general anesthesia,and an observation group(n=51),receiving TAPB combined with remimazolam for general anesthesia.A comparison was made between both groups in terms of hemodynamic parameters,stress markers,pain levels,recovery quality,analgesic effects,and adverse reactions during the perioperative period.RESULTS The observation group had significantly higher heart rates at time points 1 min after induction and upon leaving the operating room than the control group(P<0.05).The mean arterial pressure at time point T1 in the observation group was significantly higher than that in the control group(P<0.05).Five minutes after extubation,the levels of the hormones adrenaline and noradrenaline in the observation group were considerably lower than those in the control group(P<0.05).At 12 h,24 h,and 48 h following surgery,the visual analog scale scores of the observation group were considerably lower than those of the control group(P<0.05).The observation group had shorter awakening and extubation times and lower Riker sedation-agitation scale scores than the control group(P<0.05).The observation group exhibited considerably fewer effective pump presses,lower fentanyl dosages,and lower incidences of rescue analgesia within 24 h following surgery than the control group(P<0.05).CONCLUSION The application effect of TAPB combined with remimazolam general anesthesia in anesthesia of patients undergoing gastrointestinal tumor surgery is good,which is helpful to promote faster recovery after operation.展开更多
Objective:This paper aims to analyze the analgesic effect of ultrasound-guided transversus abdominis plane block(TAPB)combined with non-steroidal anti-inflammatory analgesic drug lornoxicam on abdominal surgery in pat...Objective:This paper aims to analyze the analgesic effect of ultrasound-guided transversus abdominis plane block(TAPB)combined with non-steroidal anti-inflammatory analgesic drug lornoxicam on abdominal surgery in patients with a history of drug addiction.Methods:32 patients aged 18-60 who underwent lower abdominal surgery in the First People's Hospital of Liangshan Yi Autonomous Prefecture and Butuo County People's Hospital of Liangshan Yi Autonomous Prefecture from January 2022 to March 2023 were selected,the patients must have drug abuse history for more than 1 year,with a history of drug withdrawal and relapse.The patients were divided into observation group and control group by the envelope method,with 16 cases in the observation group and 16 cases in the control group.Two groups of patients underwent ultrasound-guided bilateral transversus abdominis plane block after the operation.The observation group was treated with dexmedetomidine hydrochloride 1μg/kg+0.25%ropivacaine hydrochloride 40ml,and the control group was treated with 40ml 0.9%sodium chloride injection,the two groups of patients returned to the ward after operation and given intravenous infusion of lornoxicam for relieving the pain.The visual analogue scale(VAS)score of postoperative pain,the times of rescue analgesia,the time of postoperative anal exhaust,the time of ambulation,nausea and vomiting,withdrawal symptoms,related adverse reactions,and hospitalization days were compared between the two groups.Results:The VAS score of postoperative pain in the observation group was significantly lower than that in the control group,P<0.05.Patients in the observation group used less postoperative rescue analgesics than those in the control group,P<0.05.For postoperative anal exhaust time,the difference between the two groups of patients was relatively small,and the time in the observation group was shorter,P>0.05.The time to get out of bed and the length of hospital stay were not significantly different between the control group and the observation group,P>0.05.The withdrawal symptoms of the patients in the observation group were better,P<0.05,nausea and vomiting,and other adverse reactions were lower in the control group,P<0.05.Conclusion:Ultrasound-guided transversus abdominis plane block combined with lornoxicam can be used to relieve pain in abdominal surgery for patients with drug addiction,which can effectively improve the therapeutic effect of patients and reduce the number of postoperative rescue analgesia.Thus,it has high clinical application value.展开更多
Objective:To evaluate the analgesic effect of ultrasound-guided subcostal anterior quadratus lumborum block(QLB)for laparoscopic radical gastrectomy surgery.Methods:Patients(aged 20-65 years,ASA Ⅰ-Ⅱ,and weighing 40-...Objective:To evaluate the analgesic effect of ultrasound-guided subcostal anterior quadratus lumborum block(QLB)for laparoscopic radical gastrectomy surgery.Methods:Patients(aged 20-65 years,ASA Ⅰ-Ⅱ,and weighing 40-75 kg)scheduled for elective laparoscopic radical gastrectomy were enrolled in the current study.Sixty patients were randomly assigned to two groups by computer-generated randomization codes:an ultrasound-guided oblique subcostal transversus abdominis plane block(TAPB)group(group T,n=30)or an ultrasound-guided subcostal anterior QLB group(group Q,n=30).In both groups,bilateral ultrasound-guided oblique subcostal TAPB and subcostal anterior QLB were performed before general anesthesia with 0.25% ropivacaine 0.5 mL/kg.For postoperative management,all patients received patient-controlled intravenous analgesia(PCIA)with nalbuphine and sufentanil after surgery,maintaining visual analogue scale(VAS)scores<4 within 48 h.The intraoperative consumption of remifentanil,the requirement for sufentanil as a rescue analgesic,and the VAS scores at rest and coughing were recorded at 1,6,12,24 and 48 h after surgery.The recovery(extubation time after surgery,first ambulation time,first flatus time and length of postoperative hospital stay)and the adverse events(nausea and vomiting,skin pruritus,respiratory depression and nerve-block related complications)were observed and recorded.The primary outcome was the perioperative consumption of opioids.Results:Compared with group T,the intraoperative consumption of remifentanil,requirement for sufentanil and the frequency of PCIA were reduced in group Q.Meanwhile,VAS scores at all points of observation were significantly lower in group Q than in group T.Patients in group Q were also associated with shorter time to first out-of-bed activity and flatus,and shorter length of postoperative hospital stay than group T(P<0.05).There were no skin pruritus,respiratory depression or nerve-block related complications in both groups.Conclusion:Compared with ultrasound-guided oblique subcostal TAPB,ultrasound-guided subcostal anterior QLB provided greater opioid-sparing effect,lower visual analogue scores,and shorter postoperative hospital stay for laparoscopic radical gastrectomy.展开更多
Objective: The aim of this study is to determine the role of preoperative low dose intravenous MgSO4 when given adjuvant to ultrasound guided transversus abdominis plane (TAP) block in augmenting postcesarean analgesi...Objective: The aim of this study is to determine the role of preoperative low dose intravenous MgSO4 when given adjuvant to ultrasound guided transversus abdominis plane (TAP) block in augmenting postcesarean analgesic effects and reducing opioid requirements during the first 24 hours. Subjects and Methods: In this prospective, randomized double blind study, a total of sixty full term pregnant women were recruited for the study underwent caesarean section. Thirty patients were assigned to MgSO4 group (A) and another thirty to placebo group (B). Participants in group (A) received 50 mg/kg MgSO4 in 100 ml isotonic saline intravenous (IV) over 20 minutes prior to induction of general anesthesia by 30 minutes while participants in group (B) received 100 ml isotonic saline (placebo) by the same route and over the same duration as control. Results: Visual Analogue Scale (VAS) was analysed within 24 hours postoperatively. The mean pain score at 6 and 12 hours postoperatively was significantly lower in MgSO4 group compared to control group (40.4 ± 5.12 vs 53.6 ± 4.92;26.1 ± 3.01 vs 35.5 ± 3.98 respectively, p = 0.012, 0.005). Comparing both groups regarding the mean time interval of first rescue analgesia (morphine sulphate) requested by the patients, it was longer in MgSO4 group compared to control group. The total dose of rescue analgesia consumed during 24 hours was analysed and it was significantly higher in control group compared to MgSO4 group (10.1 ± 0.95 vs 6.2 ± 0.87, p = 0.001). Conclusion: We concluded that preoperative low doses (50 mg/Kg) of MgSO4 with general anesthesia combined with ultrasound guided TAP block offer longer postoperative pain free periods thus reducing total opioid consumption. In addition to the safety of the drug to the mother and fetus so we recommend IV MgSO4 as an adjuvant therapy with TAP block.展开更多
基金Supported by Health Commission of Hebei Province,China,No.20240074Scientific Research Project of Hebei Provincial Administration of Traditional Chinese Medicine,China,No.2024317.
文摘Laparoscopic surgery is the main treatment method for patients with gastrointestinal malignant tumors.Although laparoscopic surgery is minimally invasive,its tool stimulation and pneumoperitoneum pressure often cause strong stress reactions in patients.On the other hand,gastrointestinal surgery can cause stronger pain in patients,compared to other surgeries.Transversus abdominis plane block(TAPB)can effectively inhibit the transmission of nerve impulses caused by surgical stimulation,alleviate patient pain,and thus alleviate stress reactions.Remazolam is an acting,safe,and effective sedative,which has little effect on hemodynamics and is suitable for most patients.TAPB combined with remazolam can reduce the dosage of total anesthetic drugs,reduce adverse reactions,reduce stress reactions,and facilitate the rapid postoperative recovery of patients.
文摘BACKGROUND Transversus abdominis plane block(TAPB)is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle achieved with local anesthetics.It can effectively block the conduction of the anterior nerve of the abdominal wall and exert a good analgesic effect.However,the effect of combining the block with remimazolam on anesthesia in patients undergoing gastrointestinal tumor surgery is still unclear.AIM To examine the effects of combining TAPB with remimazolam on the stress response and postoperative recovery of gastrointestinal tumor surgery patients.METHODS A retrospective analysis was conducted on the clinical data of 102 individuals diagnosed with gastrointestinal malignancies who underwent laparoscopic surgery under general anesthesia between April 2020 and June 2023.The patients were categorized into a control group(n=51),receiving remimazolam for general anesthesia,and an observation group(n=51),receiving TAPB combined with remimazolam for general anesthesia.A comparison was made between both groups in terms of hemodynamic parameters,stress markers,pain levels,recovery quality,analgesic effects,and adverse reactions during the perioperative period.RESULTS The observation group had significantly higher heart rates at time points 1 min after induction and upon leaving the operating room than the control group(P<0.05).The mean arterial pressure at time point T1 in the observation group was significantly higher than that in the control group(P<0.05).Five minutes after extubation,the levels of the hormones adrenaline and noradrenaline in the observation group were considerably lower than those in the control group(P<0.05).At 12 h,24 h,and 48 h following surgery,the visual analog scale scores of the observation group were considerably lower than those of the control group(P<0.05).The observation group had shorter awakening and extubation times and lower Riker sedation-agitation scale scores than the control group(P<0.05).The observation group exhibited considerably fewer effective pump presses,lower fentanyl dosages,and lower incidences of rescue analgesia within 24 h following surgery than the control group(P<0.05).CONCLUSION The application effect of TAPB combined with remimazolam general anesthesia in anesthesia of patients undergoing gastrointestinal tumor surgery is good,which is helpful to promote faster recovery after operation.
基金supported by Liangshan Science and Technology Program(Project number:22ZDYF0100).
文摘Objective:This paper aims to analyze the analgesic effect of ultrasound-guided transversus abdominis plane block(TAPB)combined with non-steroidal anti-inflammatory analgesic drug lornoxicam on abdominal surgery in patients with a history of drug addiction.Methods:32 patients aged 18-60 who underwent lower abdominal surgery in the First People's Hospital of Liangshan Yi Autonomous Prefecture and Butuo County People's Hospital of Liangshan Yi Autonomous Prefecture from January 2022 to March 2023 were selected,the patients must have drug abuse history for more than 1 year,with a history of drug withdrawal and relapse.The patients were divided into observation group and control group by the envelope method,with 16 cases in the observation group and 16 cases in the control group.Two groups of patients underwent ultrasound-guided bilateral transversus abdominis plane block after the operation.The observation group was treated with dexmedetomidine hydrochloride 1μg/kg+0.25%ropivacaine hydrochloride 40ml,and the control group was treated with 40ml 0.9%sodium chloride injection,the two groups of patients returned to the ward after operation and given intravenous infusion of lornoxicam for relieving the pain.The visual analogue scale(VAS)score of postoperative pain,the times of rescue analgesia,the time of postoperative anal exhaust,the time of ambulation,nausea and vomiting,withdrawal symptoms,related adverse reactions,and hospitalization days were compared between the two groups.Results:The VAS score of postoperative pain in the observation group was significantly lower than that in the control group,P<0.05.Patients in the observation group used less postoperative rescue analgesics than those in the control group,P<0.05.For postoperative anal exhaust time,the difference between the two groups of patients was relatively small,and the time in the observation group was shorter,P>0.05.The time to get out of bed and the length of hospital stay were not significantly different between the control group and the observation group,P>0.05.The withdrawal symptoms of the patients in the observation group were better,P<0.05,nausea and vomiting,and other adverse reactions were lower in the control group,P<0.05.Conclusion:Ultrasound-guided transversus abdominis plane block combined with lornoxicam can be used to relieve pain in abdominal surgery for patients with drug addiction,which can effectively improve the therapeutic effect of patients and reduce the number of postoperative rescue analgesia.Thus,it has high clinical application value.
基金supported by Young Scholar Research Grant of Chinese Anesthesiologist Association(No.21800009).
文摘Objective:To evaluate the analgesic effect of ultrasound-guided subcostal anterior quadratus lumborum block(QLB)for laparoscopic radical gastrectomy surgery.Methods:Patients(aged 20-65 years,ASA Ⅰ-Ⅱ,and weighing 40-75 kg)scheduled for elective laparoscopic radical gastrectomy were enrolled in the current study.Sixty patients were randomly assigned to two groups by computer-generated randomization codes:an ultrasound-guided oblique subcostal transversus abdominis plane block(TAPB)group(group T,n=30)or an ultrasound-guided subcostal anterior QLB group(group Q,n=30).In both groups,bilateral ultrasound-guided oblique subcostal TAPB and subcostal anterior QLB were performed before general anesthesia with 0.25% ropivacaine 0.5 mL/kg.For postoperative management,all patients received patient-controlled intravenous analgesia(PCIA)with nalbuphine and sufentanil after surgery,maintaining visual analogue scale(VAS)scores<4 within 48 h.The intraoperative consumption of remifentanil,the requirement for sufentanil as a rescue analgesic,and the VAS scores at rest and coughing were recorded at 1,6,12,24 and 48 h after surgery.The recovery(extubation time after surgery,first ambulation time,first flatus time and length of postoperative hospital stay)and the adverse events(nausea and vomiting,skin pruritus,respiratory depression and nerve-block related complications)were observed and recorded.The primary outcome was the perioperative consumption of opioids.Results:Compared with group T,the intraoperative consumption of remifentanil,requirement for sufentanil and the frequency of PCIA were reduced in group Q.Meanwhile,VAS scores at all points of observation were significantly lower in group Q than in group T.Patients in group Q were also associated with shorter time to first out-of-bed activity and flatus,and shorter length of postoperative hospital stay than group T(P<0.05).There were no skin pruritus,respiratory depression or nerve-block related complications in both groups.Conclusion:Compared with ultrasound-guided oblique subcostal TAPB,ultrasound-guided subcostal anterior QLB provided greater opioid-sparing effect,lower visual analogue scores,and shorter postoperative hospital stay for laparoscopic radical gastrectomy.
文摘Objective: The aim of this study is to determine the role of preoperative low dose intravenous MgSO4 when given adjuvant to ultrasound guided transversus abdominis plane (TAP) block in augmenting postcesarean analgesic effects and reducing opioid requirements during the first 24 hours. Subjects and Methods: In this prospective, randomized double blind study, a total of sixty full term pregnant women were recruited for the study underwent caesarean section. Thirty patients were assigned to MgSO4 group (A) and another thirty to placebo group (B). Participants in group (A) received 50 mg/kg MgSO4 in 100 ml isotonic saline intravenous (IV) over 20 minutes prior to induction of general anesthesia by 30 minutes while participants in group (B) received 100 ml isotonic saline (placebo) by the same route and over the same duration as control. Results: Visual Analogue Scale (VAS) was analysed within 24 hours postoperatively. The mean pain score at 6 and 12 hours postoperatively was significantly lower in MgSO4 group compared to control group (40.4 ± 5.12 vs 53.6 ± 4.92;26.1 ± 3.01 vs 35.5 ± 3.98 respectively, p = 0.012, 0.005). Comparing both groups regarding the mean time interval of first rescue analgesia (morphine sulphate) requested by the patients, it was longer in MgSO4 group compared to control group. The total dose of rescue analgesia consumed during 24 hours was analysed and it was significantly higher in control group compared to MgSO4 group (10.1 ± 0.95 vs 6.2 ± 0.87, p = 0.001). Conclusion: We concluded that preoperative low doses (50 mg/Kg) of MgSO4 with general anesthesia combined with ultrasound guided TAP block offer longer postoperative pain free periods thus reducing total opioid consumption. In addition to the safety of the drug to the mother and fetus so we recommend IV MgSO4 as an adjuvant therapy with TAP block.
