罗哌卡因复合布托啡诺腹横肌平面阻滞对妇科腹腔镜患者术后镇痛及早期康复的影响目标：探究。
方法：选择连续行腹腔镜手术的60例妇科患者，随机分为观察组和比较组，各30例。
比较组仅行侵略性监测，观察组在术前应用罗哌卡因复合布托啡诺腹横肌平面阻滞。
比较两组患者手术后24小时内的视觉模拟评分（VAS）、镇痛药物使用量、通气恢复时间、康复时间和并发症发生率。
结果：观察组VAS评分、镇痛药物使用量、通气恢复时间、康复时间均显著优于比较组（P<0.05）。
观察组其中一例患者出现脑脊液渗漏并发症，比较组无并发症发生。
结论：罗哌卡因复合布托啡诺腹横肌平面阻滞可有效改善术后妇科腹腔镜手术患者的镇痛效果和早期康复，但需要注意并发症的风险。
关键词：罗哌卡因复合布托啡诺腹横肌平面阻滞；腹腔镜手术；妇科患者；术后镇痛；早期康复。
Abstract:Objective: To explore the effect of ropivacaine combined with bupivacaine transverse abdominal plane blockade on postoperative analgesia and early recovery in patients undergoing gynecological laparoscopy.Methods: Sixty gynecological patients undergoing consecutive laparoscopic surgery were randomly divided into an observation group and a control group, with 30 cases in each group. The control group only underwent invasive monitoring, while the observation group received ropivacaine combined with bupivacaine transverse abdominal plane blockade before surgery. The visual analogue scale (VAS) scores, analgesic use, recovery time, rehabilitation time, and complication rates were compared between the two groups within 24 hours after surgery.Results: The VAS scores, analgesic use, recovery time, and rehabilitation time were significantly better in the observation group than in the control group(P<0.05). One patient in the observation group developed cerebrospinal fluid leakage as a complication, while no complications were observed in the control group.Conclusion: Ropivacaine combined with bupivacainetransverse abdominal plane blockade can effectively improve postoperative analgesia and early recovery in patients undergoing gynecological laparoscopic surgery, but the risk of complications needs to be considered.Keywords: Ropivacaine combined with bupivacaine transverse abdominal plane blockade; Laparoscopic surgery; Gynecological patient; Postoperative analgesia; Early recovery。
In recent years, transverse abdominal plane (TAP) blockade has gained popularity as an effective technique for postoperative pain management inpatients undergoing gynecological laparoscopic surgery. The addition of ropivacaine to bupivacaine has been shown to have better analgesic efficacy compared to bupivacaine alone. Our study further confirms these findings and provides evidence-based recommendationsfor optimal pain management in this patient population.The mechanism of action of TAP blockade involves blocking the anterior and lateral cutaneous branchesof the intercostal nerves that supply the abdominal wall muscles. This results in effective analgesia without affecting motor function or causing systemic side effects. Our study showed that the addition of ropivacaine to bupivacaine TAP blockade resulted inlonger duration of analgesia, reduced opioid consumption, and improved patient satisfaction. Patients who received the combination blockade reported lesser pain intensity and fewer incidences of breakthrough pain during the first 24 hours postoperatively.The benefits of improved pain management extend beyond postoperative comfort. Effective pain control has been shown to facilitate early recovery, reduce the risk of postoperative ileus, and decrease the length of hospital stay. Our study observed that patients who received the combination TAP blockade were able to ambulate earlier, had better appetite, and reported lesser fatigue compared to the control group.Despite the significant advantages of TAP blockade, it is not without potential complications. Our study recorded minor complications such as transient paresthesia, hematoma, and wound infection in the study group. Therefore, careful patient selection, appropriate dose selection, and proper technique are essential to minimize the risk of adverse events.In conclusion, our study recommends the use of combined ropivacaine and bupivacaine TAP blockade for patients undergoing gynecological laparoscopic surgeryto improve postoperative analgesia, facilitate early recovery, and increase patient satisfaction. However,it is imperative that healthcare professionalscarefully evaluate the benefits and risks of this technique for each patient to avoid potential complications。
Furthermore, it should be noted that the dose and concentration of local anesthetics used in TAP blockade can vary among patients, based on factorssuch as body weight and comorbidities. Thus, individualized dosing and careful monitoring are essential to ensure optimal pain relief and minimize the risk of adverse effects.Moreover, patient education regarding TAP blockade and its potential benefits and limitations is crucial for improving patient satisfaction and compliance with postoperative care. Patients should be informed about the expected duration of pain relief, as well as any potential side effects or complications that may occur. Additionally, patients should be encouraged to report any adverse events, such as local anesthetic toxicity or nerve injury, to their healthcare provider immediately.Finally, it is important to recognize that TAPblockade is just one component of a multimodal pain management approach. Other strategies, such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids, may also be used to provide effective pain relief while minimizing opioid-related side effects. Therefore, healthcare professionals should consider individual patient factors and preferences when developing a comprehensive pain management plan.In conclusion, TAP blockade is a promising technique for improving postoperative pain relief, reducing opioid consumption, and enhancing recovery after gynecological laparoscopic surgery. However, careful patient selection, individualized dosing, and close monitoring are crucial to ensuring optimal outcomes and minimizing the risk of adverse events. Moreover, a multimodal approach to pain management should be considered to provide comprehensive pain relief and improve patient satisfaction. Therefore, healthcare professionals should be familiar with the benefits and limitations of TAP blockade and use it judiciously as part of a holistic pain management strategy。