Effect Of General Anesthesia Combined With Transversus Abdominis Plane Block On Physical Stress And Immune System In Patients Underwent Radical Gastrectomy For Gastric Cancer

Objective:To evaluate the effects of combining general anesthesia and bilateral ultrasound transversus abdominis plane block on stress reaction and Immunosuppression of the patients who received radical gastrectomy during perioperative period,in order to give academic evidence for the elections of anaesthesia method.Method:40 patients who had been scheduled to undergo radical gastrectomy during September to November 2015 were randomly enrolled into control group(Group R, n=20) and observation group(Group S, n=20).After induction of general anesthesia, patients in both groups were received ultrasound-guided TAP block, with multiple injections of 40 ml ropivacaine(Group R) or 40 ml normal saline(Group S) respectively under bilateral costal margin. Glucose(Glu), cortisol(Cor), C-reactive protein(CRP), interleukins-2(IL-2), interleukins-6(IL-6), interleukins-10(IL-10) were measured just before anesthesia(T0),after induction(T1), 10 minutes after skin incision(T2), 2 hours after skin incision(T3), extubation(T4),24 hours after surgery(T5). To investigate the effects caused by two different anaesthesia methods on stress reaction and Immunosuppression during perioperative period. The statistical data were analyzed by SPSS19.0 system. Using independent sample T test and rank-sum test. A P value less than 0.05 was considered statistically significant. A P value less than 0.01 was considered statistically highly significant.Results:Forty patients undergoing radical gastrectomy were randomly divided into two groups, baseline patient characteristics were similar in the two groups. There were no complications attributable to the TAP block in both groups.1. Blood glucose, CRP, Cor, IL-6, IL-10 were positively associated with stress response.(1)Compared with T0, mean(±sd) serous level of Cor、Glu、IL-6 were significantly raised at T3 and T4, and the level fluctuates more stably in patients undergoing TAP blockade.(2)IL-2 was negative associated with stress response, the decreased range of R group is lower than S group(P<0.01).(3)There were no significant differences in levels of CRP between two groups at any time point.2. IL-10 was positively associated with Immunosuppression,Compared with placebo block, mean(±sd) serous level of IL-10 in the first 24 postoperative hours was significantly reduced(44.25±10.76 vs 61.78±12.36, P<0.01). IL-2 was negative associated with Immunosuppression, the decreased range of R group is lower than S group(P<0.01).Conclusion:Combined ultrasound-guided TAP block could effectively inhibit the stress response, has little impact on serum cortisol and cytokines and may even bring about some improvement to postoperative immune function in patients in radical gastrectomy for gastric cancer.