Abstract
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.
Funder
Natural Science Foundation of Jilin Province
Publisher
Springer Science and Business Media LLC
Subject
Anesthesiology and Pain Medicine
Reference34 articles.
1. Long AJ, Burton PR, De Veer MJ, Ooi GJ, Laurie CP, Nottle PD, Watt MJ, Brown WA. Radical gastric cancer surgery results in widespread upregulation of pro-tumourigenic intraperitoneal cytokines. ANZ J Surg. 2018;88(5):E370–6.
2. Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85(1):109–17.
3. Li K, Li L, Gao M, Zhu Z, Chen P, Yang L, Zhao G. Application of ultrasound-guided subcostal transversus abdominis plane block in gastric cancer patients undergoing open gastrectomy. Int J Clin Exp Med. 2015;8(8):13976.
4. Brodner G, Van Aken H, Hertle L, Fobker M, Von Eckardstein A, Goeters C, Buerkle H, Harks A, Kehlet H. Multimodal perioperative management--combining thoracic epidural analgesia, forced mobilization, and oral nutrition--reduces hormonal and metabolic stress and improves convalescence after major urologic surgery. Anesth Analg. 2001;92(6):1594–600.
5. Holte K, Kehlet H. Epidural anaesthesia and analgesia - effects on surgical stress responses and implications for postoperative nutrition, Clinical nutrition (Edinburgh, Scotland). 2002;21(3):199–206.