布比卡因脂质体腹横肌平面阻滞在腹腔镜妇科 手术镇痛中的应用效果观察.

Objective To observe the application effect of bupivacaine liposome transversus abdominis plane block (TAPB) on postoperative pain and stress response in patients undergoing laparoscopic gynecological surgery. Methods Totally 120 patients undergoing laparoscopic gynecological surgery were randomly divided into two groups： the bupivacaine liposome group (LB group) and the ropivacaine group (L group) . Patients in the LB group received bupivacaine liposome TAPB before the start of the surgery, while patients in the L group received an equivalent dose of ropivacaine TAPB. Postoperative pain was assessed by using the Numerical Rating Scale (NRS) at 6 h (T1), 24 h (T2), 48 h (T3), 60 h (T4), and 72 h (T5) for 72 consecutive h after surgery, with the number of analgesic pump button presses and rescue analgesia requirements recorded. Additionally, venous blood was drawn from patients before operation (D0) and on the 1st (D1), 3rd (D3), and 7th (D7) days after surgery, and the serum levels of cortisol, interleukin-6(IL-6), and tumor necrosis factorα(TNF-α) were measured. The Quality of Recovery-40(QoR-40) scale was used to assess the quality of recovery at 24, 48, and 72 h postoperatively, and we recorded the postoperative nausea and vomiting (PONV), urinary retention, pruritus and incision infection in the two groups. Results NRS scores significantly decreased over time in both groups (all P< 0.05) . The NRS scores at T2 to T4 in the LB group were lower than those of the L group (all P<0.05) . The number of postoperative remedial analgesia and the number of analgesic pump button presses in the LB group were smaller than those in the L group (all P<0.05) . The levels of serum cortisol, IL-6, and TNF-α in both groups showed a trend of first increasing and then decreasing after surgery. The levels of serum cortisol, IL-6, and TNF-α on the 3rd day after surgery in the LB group were lower than those in the L group (all P<0.05) . The QoR-40 scores increased over time in both groups, with a more significant increase in the LB group (P<0.05) . The incidence of PONV was lower in the LB group than in the L group (P<0.05), while there were no significant differences in the occurrence of urinary retention, pruritus, or incision infection between the two groups (all P>0.05) . Conclusion Bupivacaine liposome TAPB showed a long-lasting analgesic effects in laparoscopic gynecological surgery and could reduced postoperative stress response, improve the quality of postoperative recovery and had high safety. [ABSTRACT FROM AUTHOR]