Transversus abdominis plane block with general anesthesia blunts the perioperative stress response in patients undergoing radical gastrectomy

Ruizhu Liu, Haiyan Qin, Meng Wang, Kai Li, Guoqing Zhao, Ruizhu Liu, Haiyan Qin, Meng Wang, Kai Li, Guoqing Zhao

Abstract

Background: Surgical stress induces the release of neuroendocrine mediators and cytokines during perioperative period, which may have adverse effects on cancer patients. While the surgical stress responsse can be affected by anesthetic technique. Therefore, we designed this study to assess whether subcostal transversus abdominis plane (TAP) block can affect perioperative neuroendocrine stress response, postoperative analgesia and postoperative recovery in patients undergoing radical gastrectomy under general anesthesia.

Methods: Sixty-five patients were recruited. Patients randomly received general anesthesia (control group), or general anesthesia combined with TAP block (40 mL of 0.375% ropivacaine) (TAP group). The primary outcome was neuroendocrine levels including norepinephrine (NE), epinephrine (E), cortisol (Cor), glucose (Glu), interleukin (IL)-6 and IL-10 during 48 h after surgery. Secondary outcomes included pain score, hemodynamic variables and recovery characteristics.

Results: Data from 61 of 65 patients were analyzed. The levels of NE, E, Cor, and Glu were blunt by TAP block during perioperative period. The levels of IL-6 and IL-10 were significantly lower in TAP group than in control group. TAP block efficiently relieved postoperative acute pain up to 12 h postoperatively with more stable perioperative hemodynamics compared with control group.

Conclusions: Subcostal TAP block blunts perioperative stress response and provides efficient analgesia, with good hemodynamic stability and minimal adverse effects.

Keywords: Analgesia; Gastric cancer; Nerve block; Stress.

Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Plasma concentration of norepinephrine (NE) (a), epinephrine (E) (b), cortisol (Cor) (c), and glucose (Glu) (d). TAP: transversus abdominis plane. Time interval is defined as time between baseline and postoperative time. Data are expressed as mean ± SD. #: P < 0.05 compared with TAP group; *: P < 0.05 compared with baseline
Fig. 2
Fig. 2
Serum concentration of interleukin (IL)-6 (a), IL-10 (b), and ratio of IL-6/IL-10 (c). TAP: transversus abdominis plane. Time interval is defined as time between baseline and postoperative time. Data are expressed as mean ± SD. #: P < 0.05 compared with TAP group; *: P < 0.05 compared with baseline
Fig. 3
Fig. 3
Hemodynamic changes during operation and 2 days postoperatively. a heart rate (HR); b mean arterial blood pressure (MAP). TAP: transversus abdominis plane. Data are expressed as mean ± SD. #: P < 0.05 compared with TAP group; *P < 0.05 compared with baseline

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