关键词: 原发性肝癌, 腹腔镜下肝叶切除术, 腹横肌平面阻滞, 罗哌卡因, 曲安奈德, 镇痛

Abstract: Objective The aim of this study was to investigate the application of ropivacaine and triamcinolone for transversus abdominis plane block (TAPB) analgesia in patients with primary liver cancer (PLC) after laparoscopic hepatectomy (LH). Methods 74 patients with PLC were encountered in our hospital between February 2018 and February 2022, and all underwent LH. As for the post-operational analgesia, the patients were randomly divided into control (n=37) and observation (n=37) groups. The patients in the control group were given ropivacaine, while those in the observation group were additionally given triamcinolone for TAPB at base of ropivacaine. The postoperative pain was evaluated by scores of visual analogue scale (VAS). Serum substance P (SP), neuropeptide Y (NPY), dopamine (DA) and norepinephrine (NE) levels were detected by ELISA, and serum malondialdehyde (MDA), superoxide dismutase (SOD) and total antioxidant capacity (T-AOC) were detected by thibabituric acid, xanthine oxidation and microdetermination, respectively. Results At 12 h, 24 h and 48 h after surgery, the cumulative consumption of oxycodone in the observation group was significantly lower than in the control group[5.9±1.1)mg, (10.1±1.9)mg and (12.8±2.8)mg vs. (7.1±1.5)mg,(12.3±2.4)mg and (15.1±3.0)mg, P＜0.05]; the static VAS scores were (2.1±0.4), (2.4±0.7) and (2.2±0.5), significantly lower than [(2.7±0.6), (3.1±0.8) and (2.7±0.6), P＜0.05] in the control, and the dynamic state of VAS were (3.4±0.8), (3.1±0.7) and (2.8±0.6), also significantly lower than [(4.0±0.9),(4.2±1.0) and (3.6±0.9), P＜0.05] in the control; at 24 hours post-operationally, serum SP, NPY, DA and NE levels were (2.9±0.7)g/mL, (200.2±37.6)pg/mL, (95.3±17.6)mmol/L and (3.1±0.8)pg/mL, all significantly lower than [(3.5±0.6)g/mL, (233.5±31.4)pg/mL, (128.9±16.3)mmol/L and (3.9±1.1)pg/mL, respectively, P＜0.05] in the control, and the same differences were found at 48 hour post-operationally (P＜0.05); there were no significant differences respect to serum SOD, T-AOC and MDA levels in the two groups at 24 and 48 hours post-operationally (P＞0.05). Conclusion The administration of ropivacaine and triamcinolone combination for TAPB analgesia is efficacious in patients with PLC after LH, and the application of triamcinolone could effectively prolong analgesia and reduce body stress reactions.

Key words: Hepatoma, Laparoscopic hepatectomy, Transversus abdominis plane block, Postoperative analgesia, Ropivacaine, Triamcinolone