关键词:

结肠癌, 腹腔镜手术, 氢吗啡酮, 腹横肌平面阻滞, 快速康复外科理念

Abstract:

Objective　To evaluate the effect applying ultrasound-guided transverse abdominis plane block (TAP) and hydromorphone in fast-track surgery (FTS) after laparoscopic radical resection for elderly patients with colon cancer. Methods　Two hundred and two elderly patients with colon cancer who underwent laparoscopic radical resection at Hospital of 73rd Group Army from April 2020 to April 2023 were selected for the randomized controlled trial, including 122 males and 80 females who were 65-85 years old. The patients were divided into a TAP group (67 cases), a TAP+H group (68 cases), and an H group (67 cases) by the random number table method. The TAP group were given 20 ml 0.25% ropivacaine under the ultrasound-guided TAP; the TAP+H group were given 20 ml 0.25% ropivacaine under the ultrasound-guided TAP and hydromorphone by intravenous analgesia pumps; the H group were given hydromorphone by intravenous analgesia pumps. The heart rates (HR), mean artery pressures (MAP), pain scores of Visual Analogue Scale (VAS), and numbers of injections of intravenous salvage analgesics 1, 8, and 48 h after the surgery and incidences of adverse reactions were compared between the 3 groups. t test and rank sum test were used. Results　One and eight hours after the surgery, the HR's and MAP's in the H group were higher than those in the TAP+H group [(83.93± 5.61) times/min vs. (80.62± 7.10) times/min, (88.28±4.79) mmHg (1 mmHg=0.133 kPa) vs. (81.97+5.12) mmHg, and (84.78±4.08) times/min vs. (81.18±3.90) times/min, and (91.54±5.33) mmHg vs. (82.32±5.60) mmHg], with statistical differences (t=2.01, 2.38, 2.15, and 2.04; all P<0.05). Eight and forty-eight hours after the surgery, the HR's and MAP's in the TAP group were higher than those in the TAP+H group [(85.84± 5.21) times/min vs. (81.18± 3.90) times/min, (85.61±4.91) mmHg vs. (82.32±5.60) mmHg, (87.32± 4.51) times/min vs. (86.10± 3.40) times/min, and (93.51±6.17) mmHg vs.(90.22±4.85) mmHg], with statistical differences (t=2.36, 2.83, 2.00, and 2.21; all P<0.05). Within 48 h after the surgery, the incidences of nausea and vomiting and the incidences of headache and dizziness in the TAP group (19.4% and 1.5%) and the TAP+H group (25.0% and 4.4%) were relatively lower. Conclusions　The application of ultrasound-guided transverse abdominis plane block combined with hydromorphone in fast-track surgery of elderly patients taking laparoscopic radical resection for colon cancer is effective. It enhances the analgesic effect, reduces the elderly patients' postoperative physical stress response and adverse reactions, promotes their independent eating, and achieves fast recovery.

Key words:

Colon cancer, Laparoscopic surgery, Hydromorphone, Transverse abdominis plane block, Fast-track surgery