Effects of ropivacaine mixed with tramadol for quadratus lumborum block on postoperative cognition and rapid recovery in elderly patients with prostate cancer
AIM To observe the effects of ropivacaine mixed with tramadol for quadratus lumborum block(QLB)on postoperative cognition and rapid recovery in elderly prostate cancer surgery.METHODS 50 elderly patients undergoing laparoscopic radical prostatectomy were randomized into control group(group C)and trial group(group T),with 25 patients in each group.All patients received endotracheal intubation total intravenous anesthesia combined with bilateral QLB anesthesia.Patients in group C received 25 mL of 0.3％ropivacaine,while patients in group T received 25 mL of 0.3％ropivacaine mixed with tramadol 2 mg·kg-1 on each side 20 min before anesthesia.The mean arterial pressure(MAP)and heart rate(HR)at 5 minutes before skin incision,10 minutes after skin incision,the end of surgery and 10 minutes after extubation,intraoperative remifentanil dosage,and sedation-agitation scale(SAS)score after awakening were recorded.The Prince-Henry pain score(PHPS)was evaluated at 2,12,24,and 48 h after surgery.Central venous blood was collected and the serum levels of C-reactive protein(CRP)and high mobility group box protein 1(HMGB1)were tested 1 h before surgery and 2 h after the surgery.Patients'cognitive function was evaluated at 1 d before surgery and 24 h after surgery using the Montreal cognitive assessment(MoCA)table,and the postoperative first activity time,anus exhaust time,eating time and patients'satisfaction score were also recorded.RESULTS Compared with group C,MAP and HR at 10 minutes after skin incision,the end of surgery and 10 minutes after extubation were lower in group T(P＜0.05),the remifentanil dosage was reduced in group T(P＜0.05),and the awakening SAS score was lower in group T(P＜0.05).At 24 and 48 h after surgery,the PHPS was lower in group T than in group C(P＜0.05).The CRP and HMGB1 levels at 2 h after the surgery were lower in group T than in group C(P＜0.05).Compared with group C,the MoCA scores at 24 h after surgery were higher in group T(P＜0.05).The postoperative first activity time,anus exhaust time and eating time were significantly shorter in group T than in group C(P＜0.05).Patients in group T had higher satisfaction scores than those in group C(P＜0.05).CONCLUSION Ropivacaine mixed with tramadol for quadratus lumborum block(QLB)applied in elderly prostate cancer surgery,can maintain a more stable perioperative hemodynamics,provide better postoperative analgesia,reduce levels of inflammatory cytokines CRP and HMGB1,improve postoperative cognitive function and is conducive to rapid recovery after surgery.
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