Efficacy Of Transversus Abdominis Plane Block Combined With General Anesthesia In Elderly Patients Undergoing Laparoscopic Surgery

Objectives:To evaluate the efficacy of transversus abdominis plane（TAP）block combined with general anesthesia in elderly patients undergoing laparoscopic surgery.Methods:Sixty American Society of Anesthesiologists physical statusⅠorⅡpatients of both sexes,aged 65⁸0 yr,with body mass index of18.5²4.0 kg/m²,scheduled for elective abdominal laparoscopic surgery,were divided into 2 groups（n=30 each）using a random number table:general anesthesia group（group GA）and TAP block combined with general anesthesia group（group TAP+GA）.Exclusion criteria:Patients with infection,dysfunction of blood coagulation,mental sickness and anaphylaxis of local anesthetic.The anesthesia time is at 8:30 am,patients in group GA were induced by general anesthesia,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.20 minutes later,the patients were induced by general anesthesia.Anesthesia was induced with IV midazolam 0.05 mg/kg,etomidate 0.2 mg/kg,sufentanil 0.4μg/kg and cisatracurium besylate 0.2mg/kg.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained by IV infusion of propofol 4¹0 mg·kg^-1·h^-1and remifentanil 0.05⁰.20μg·kg^-1·min^-1.Bispectral index value was maintained at 40⁶0 and the fluctuating amplitude of mean arterial pressure and heart rate not less than 20%of the baseline value.Muscle relaxation was maintained with intermittent IV boluses of cisatracurium besylate 0.05mg/kg.When increase in mean arterial pressure during operation>20%³0%of the baseline value,sufentanil 0.1μg/kg was injected intravenously.When postoperative VAS score≥4,dezocine 5 mg was intravenously injected for analgesia.The heart rate（HR）and mean arterial pressure（MAP）at 5 min after admission to the operating room（T₀）,at 2 min before skin incision（T₁）,at 2min after skin incision（T₂）,and at the end of pneumoperitoneum（T₃）were recorded.Points venous blood at T₀,T₂ and T₃ 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 adverse reactions such as intraoperative hypertension,hypotension,tachycardia and bradycardia was also recorded.Pain was recorded using VAS score at 2,4,6,12,24 h after surgery.Postoperative requirement for dezocine,the adverse situation of transversus abdominis plane block（local anesthetics poisoning,puncture site infection or hematoma）and adverse reactions such as nausea and vomiting were also recorded.Results:Compared with group GA,the HR,MAP and 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,postoperative requirement for dezocine,and postoperative at 4,6,12,24 h VAS scores were decreased（P<0.05）.In group TAP+GA,elderly patients had no local anesthetic toxicity,puncture site infection or hematoma caused by the transversus abdominis plane block.2 groups of patients with hypertension and sinus tachycardia were no significant difference,the incidence of postoperative nausea and vomiting were not found in the case.Conclusion:When transversus abdominis plane 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.