Enhanced analgesic efficacy and reduced stress response with ropivacaine transversus abdominis plane block in laparoscopic myomectomy.

Abstract

Background: Managing postoperative pain and stress response was critical in laparoscopic myomectomy, a procedure for uterine fibroids. Ropivacaine transversus abdominis plane block (RTAPB) may offer enhanced analgesic efficacy and reduced stress responses compared to traditional analgesia.

Methods: This retrospective analysis examined 217 patients undergoing laparoscopic myomectomy at Hankou Hospital of Wuhan from June 2020 to September 2023. Patients were divided into routine analgesia (CA, n = 105) and RTAPB (n = 112) groups. Pain levels were assessed using the Visual Analog Scale (VAS). Stress hormone levels (cortisol, norepinephrine, Interleukin-6), preoperative and postoperative recovery, sleep quality, hemodynamic stability, complications, and patient satisfaction were evaluated post-surgery.

Results: The RTAPB group demonstrated significantly lower postoperative VAS pain scores at all measured intervals (P < 0.05). Stress hormones (postoperative cortisol, norepinephrine, and IL-6) were substantially lower in the RTAPB group compared to CA (P < 0.05), indicating reduced stress response. Intraoperative hemodynamic stability was improved with RTAPB, reflected in lower heart rate and mean arterial pressure (P < 0.05). Postoperative recovery and sleep quality were also better in the RTAPB group, as evidenced by higher QoR-40 and lower PSQI scores (P < 0.01). Although not statistically significant, RTAPB showed a trend toward fewer complications. Patient satisfaction, particularly with pain management, was significantly higher in the RTAPB group (P < 0.001).

Conclusion: RTAPB significantly enhances analgesic efficacy and moderates the physiological stress response in laparoscopic myomectomy patients compared to routine analgesia.