艾司氯胺酮复合罗哌卡因超声引导下腹横肌平面阻滞用于腹腔镜直肠根治术的镇痛效果

Analgesic Effect of Esketamine Combined with Ropivacaine in Ultrasound-Guided Lower Transverse Abdominal Muscle Plane Block for Laparoscopic Radical Rectal Resection

摘要: 目的：评价在腹腔镜直肠癌根治术中应用艾司氯胺酮复合罗哌卡因实施超声引导下腹横肌平面阻滞(TAPB)的镇痛效果。方法：选择择期腹腔镜直肠根治术患者60例，使用随机数字表法分为罗哌卡因组(L组)和罗哌卡因复合艾司氯胺酮组(LS组)，每组30例。两组均在术前行双侧TAPB，术毕采用相同的患者静脉自控镇痛(PCIA)。记录术中麻醉药的消耗量；评估术后不同时刻的疼痛视觉模拟评分(VAS评分)，PCIA按压的次数和补救性布托菲诺总量；记录术后病人的恢复情况和不良反应的发生情况及患者满意度。结果：与L组相比，LS组术中麻醉药消耗量明显降低(P < 0.05)；LS组24 h内静息和运动VAS评分明显降低(P < 0.05)；术后镇痛泵按压次数和补救性使用布托菲诺量明显减少(P < 0.05)，首次下地时间明显缩短(P < 0.05)，术后满意度显著提高(P < 0.05)；两组术后不良反应对比，差异无统计学意义(P > 0.05)。结论：艾司氯胺酮复合罗哌卡因超声引导TAPB用于腹腔镜直肠癌根治术的患者，可延长镇痛时间，增强镇痛效果，减少术中术后阿片类镇痛药物使用，提高患者满意度，且不增加不良反应，安全有效。

Abstract: Objective: To evaluate the analgesic effect of ultrasound-guided lower transverse abdominal muscle plane block (TAPB) with esketamine combined with ropivacaine during laparoscopic radical resec-tion of rectal cancer. Methods: Sixty patients undergoing elective laparoscopic radical rectotomy were divided into ropivacaine group (group L) and ropivacaine combined with esketamine group (group LS) by random number table method, with 30 cases in each group. Both groups underwent bilateral TAPB before surgery and were treated with the same patient-controlled intravenous an-algesia (PCIA) after surgery. Intraoperative anesthetic consumption was recorded; Pain visual ana-logue scale (VAS), number of PCIA compressions and total number of remedial Butofino were eval-uated at different postoperative moments. The postoperative recovery of patients, the occurrence of adverse reactions and patient satisfaction were recorded. Results: Compared with the L group, the consumption of anesthesia in the LS group was significantly lower (P < 0.05); The scores of resting VAS and exercise VAS were significantly decreased in LS group within 24 hours (P < 0.05); Postop-erative analgesic pump compressions and remedial butofino use were significantly reduced (P < 0.05), the time of first landing was significantly shortened (P < 0.05), postoperative satisfaction sig-nificantly increased (P < 0.05); There was no significant difference in postoperative adverse reac-tions between the two groups (P > 0.05). Conclusion: Esketamine combined with ropivacaine ultra-sound guided TAPB for patients undergoing laparoscopic radical resection of rectal cancer can pro-long analgesic time, enhance analgesic effect, reduce intraoperative and postoperative opioid anal-gesic drug use, improve patient satisfaction, and do not increase adverse reactions, so it is safe and effective.