Modifying efficacy of transversus abdominis plane block combined with general anesthesia in elderly patients undergoing laparoscopic surgery / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the modifying efficacy of transversus abdominis plane (TAP) block combined with general anesthesia in elderly patients undergoing laparoscopic surgery.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 65-80 yr,with body mass index of 18.5-24.0 kg/m2,scheduled for elective abdominal laparoscopic surgery,were divided into 2 groups (n =30 each) using a random number tablegeneral anesthesia group (group GA) and TAP block combined with general anesthesia group (group TAP+GA).In group TAP+GA,bilateral TAP block was performed using the posterior approach,and 0.25％ ropivacaine 20 ml was injected into the two sides.Anesthesia was induced with Ⅳ midazolam,etomidate,sufentanil and cisatracurium besylate.Anesthesia was maintained using total intravenous anesthesia.When postoperative visual analog scale score ≥4,dezocine 5 mg was intravenously injected for analgesia.At 5 rmin after admission to the operating room,at 2 min after skin incision and at the end of pneumoperitoneum,venous blood samples were collected for determination of plasma norepinephrine concentrations.The intraoperative consumption of propofol and remifentanil and intraoperative requirement for sufentanil and postoperative requirement for dezocine were recorded.The development of adverse reactions was also recorded.Results Compared with group GA,the plasma norepinephrine concentrations were significantly decreased at 2 min after skin incision and at the end of pneumoperitoneum,the intraoperative consumption of propofol and remifentanil was reduced,the intraoperative requirement for sufentanil and postoperative requirement for dezocine were decreased (P＜0.05),and no significant change was found in the incidence of adverse reactions in group TAP+GA (P＞0.05).Conclusion When TAP block combined with general anesthesia is used in elderly patients undergoing laparoscopic surgery,it is helpful in carrying out anesthetic model of low-consumption opioids and more helpful in inhibiting intraoperative stress responses and postoperative pain responses than general anesthesia alone.