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| Effect of different analgesic methods on postoperative rehabilitation of patients undergoing transabdominal myomectomy in enhanced recovery after surgery mode |
| HAN Xudong DU Lifang PING Chunzhi ZHANG Xiaolan |
| Department of Anesthesiology, Gansu Provincial Maternity and Child Care Hospital, Gansu Province, Lanzhou 730050, China |
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Abstract Objective To evaluate the effect of different analgesic methods on postoperative rehabilitation of patients undergoing transabdominal myomectomy in enhanced recovery after surgery（ERAS） mode. Methods A total of 50 patients with uterine fibroids, scheduled transabdominal myomectomy in Gansu Provincial Maternity and Child Care Hospital from March to October 2019 were divided into group M and group C by random number table method, with 25 cases in each group. Group M were treated with acetaminophen 500 mg and Ibuprofen 600 mg oral administration in preoperative, 0.25% Ropivacaine 20 mL infiltration at incision before the end of the operation and taken Tramadol 100 mg postoperative three times a day for three days. Group C were treated with intravenous patient controlled analgesia for 48 h. The visual analogue score (VAS) of the two groups were recorded at 3 h (T1), 6 h (T2),12 h (T3) and 24 h (T4) after operationin. The time of anal exhaust in postoperative, hospital stay, hospitalization cost and the rate of pruritus, nausea and vomiting, urinary retention, SpO2＜94% and rescue analgesia were recorded in the two groups. A total of 3 mL of venous blood were taken at 2 h (T0) and T4 before surgery and interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected by enzyme-linked immune assay. Results There was difference in VAS score between different time points (P ＜ 0.05), the difference of VAS scores between groups was statistically significant (P ＜ 0.05). there was interaction between different time points and the two groups (P ＜ 0.05), The VAS score of group M at T1 was lower than that of group C (P ＜ 0.05). Compared with T1, the VAS score of group M increased at T2-T4 (P ＜ 0.05), while VAS score of group C decreased at T2-T4 (P ＜ 0.05). Compared with T2, the VAS score of group M increased at T4 (P ＜ 0.05). The anal exhaust time of group M was earlier than that of group C (P ＜ 0.05). There was no significant difference between two groups in hospital stay and hospitalization cost（P ＞ 0.05）. The number of patients with skin pruritus, nausea and vomiting and rescueanalgesia in group M were less than those in group C (P ＜ 0.05). There was no significant difference in the number of urinary retention and SpO2＜94% between the two groups (P ＞ 0.05). Compared with T0, the concentrations of IL-6 and TNF-α in the two groups were increased at T4 (P ＜ 0.05). Compared with group C, the concentrations of IL-6 and TNF-α in group M were decreased at T4 (P ＜ 0.01). Conclusion Under the ERAS mode, the multi-mode analgesic mode of nsaids combined with central analgesics and local anesthetics in the perioperative period of gynecological open surgery can effectively reduce the pain and inflammatory response of patients and promote the early rehabilitation of patients.
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