| Objective:To investigate the effects of ultrasound-guided transversus abdominis plane?TAP?block on stress response and rehabilitation in patients undergoing laparoscopic resection of rectal cancer,which could provide the experimental basis for the anesthesia choices of patients with rectal cancer.Methods:According to the random number table,60 patients?aged 3570 years,BMI 18.535.0 kg/m2,ASA grade I to II?scheduled for laparoscopic resection of rectal cancer under general anesthesia were assigned to undergo TAP block with ropivacaine?group T,n=30?versus control group?group P,n=30?with normal saline.Bilateral ultrasound-guided TAP blocks were administered in the preanesthesia room,group T received TAP block using 0.375%ropivacaine,0.5ml/kg on each side,while group P received equivalent normal saline.Both groups received intravenous sufentanil patient-controlled analgesia post-operatively.Mean arterial pressure and heart rate were recorded when entering the operation room?T1?,5 minutes after tracheal intubation?T2?,5 minutes after establishment of pneumoperitoneum?T3?,the end of operation?T4?,24 hours post-operative?T7?,and 48 hours post-operative?T8?.Also the dosages of propofol and remifentanil during the operation and the cumulative sufentanil usage within 24 hours post-operative were recorded.And the patient-controlled analgesia press for the first time were concerned.Visual analogue scale?VAS?scores and comfort scale scores were evaluated when leaving the recovery room?T5?,6 hours post-operative?T6?,T7 and T8.Arterial blood samples were obtained at T1,T3,T4,T7,T8,and the C reactive protein?CRP?,cortisol?COR?,interleukin-6?IL-6?,and norepinephrine?NE?levels were detected by enzyme-linked immunosorbent assay.The first exhaust or defecation time,catheter removal time,hospital stay,and the degrees of satisfaction with postoperative analgesia were recorded.The intraoperative and postoperative complications related to anesthesia were also concerned.Results:The baseline characteristics of the two groups were similar in terms of age,sex,body mass index?BMI?,operation time,and blood loss?P>0.05?.Compared with group P,mean arterial pressure and heart rate in group T were significantly lower at T3 and T4?P<0.05?.And the group T consumed less remifentanil,propofol and sufentanil than group P?P<0.05?,while there were no significant differences in vasoactive agents usage?P>0.05?.No significant differences were observed between the groups in levels of CRP and IL-6?P>0.05?.In comparison with group P,the levels of COR at T3 and T4 in group T were significantly lower?P<0.05?,and significantly lower levels of NE were detected at T3,T4 and T7 in group T?P<0.05?.Compared with group P,the first time of postoperative patient-controlled analgesia press in group T prolonged?P<0.05?.In group T,the VAS scores were significantly lower at T5,T6 and T7 than group P?P<0.05?,and the comfort scale scores of T5 and T6 were significantly higher?P<0.05?,otherwise,the degrees of satisfaction with postoperative analgesia were significantly higher than group P?P<0.05?.There were no significant differences between the groups in the first exhaust or defecation time,catheter removal time,hospital stay and complications?P>0.05?.Conclusion:1.TAP block carried out before anesthesia induction decreases hemodynamic fluctuations of patients undergoing laparoscopic resection of rectal cancer.2.TAP block suppresses the neuroendocrine response caused by surgical stimulation,but has no significant effects on the levels of IL-6 and CRP.3.TAP block significantly reduces postoperative resting VAS scores,improves the postoperative comfort scale scores and the degrees of satisfaction with postoperative analgesia.4.There are no differences in the postoperative first exhaust defecation time,catheter removal time,hospitalization time and complications. |
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