Effects Of Ultrasound-guided Transverse Abdominal Block On Postoperative Analgesia And Cognitive Dysfunction In Elderly Patients Undergoing Laparoscopic Radical Gastrectomy

Objective:to observe the effect of Transversus AbdominisPlane Block(TAPB or TAP)on postoperative analgesia and postoperative cognitive dysfunction in elderly patients undergoing laparoscopic gastric cancer surgery.Method:from March 2018 to October 2018 line during laparoscopic assisted the 60 cases of elderly patients with gastric cancer radical included in this study,ASA sizing ??? level.Random number table method was used to divide into two groups:control group(group C),observer group(group T),30 cases in each group.After entering the operating room,non-invasive blood pressure(BP),electrocardiogram(ECG),pulse oxygen saturation(SPO2),heart rate(HR)and BIS index were routinely monitored,upper brachial vein access was opened,and body temperature was monitored.According to the unified standard of general anesthesia inductionitracheal intubation was performed after muscle relaxation,and mechanical ventilation was performed afterwards.In both groups of patients,right internal jugular vein puncture and catheterization were performed under the guidance of b-ultrasound to measure central venous pressure(CVP)and intraoperative infusion medication.Intraoperative blood pressure was maintained at 20%of prebasal blood pressure,PetC02 was maintained between 30-45mm Hg,BIS was maintained stable in the range of 40-60,and bilateral TAP block was performed under ultrasound guidance after 5 to 10 minutes after intubation.Group T:0.375%ropivacaine,15ml on each side,bilateral block by subcostal approach.Group C was the control group,and the same amount of normal saline was injected at the same location.All were performed by the same anesthesiologist.PCIA analgesia pump was used in both groups after the operation.VAS pain scores at 2,6,12 and 24 hours after surgery(0?10 points)were observed and recorded.The first compression time of postoperative analgesic pump,the number of compressions within 24 hours and the dosage of sufentanil of PCIA within 24 hours were compared between the two groups,and the number of tapb-related complications occurred.Postoperative complications such as nausea and vomiting,as well as postoperative cognitive dysfunction at 1,3 and 5 days were recorded.Results:there were no significant differences between the two groups in age.gender,body mass index,ASA classification,education time;operation time and anesthesia time(P>0.05).There was no significant difference in scores of simple intelligence between the two groups before surgery(P>0.05).Compared with the control group,the intraoperative dosage of remifentanil and propofol in the observer group were reduced(P<0.05).T he dosage of sufentanil decreased within 24 hours after surgery(P<0.05),and VAS scores decreased 2 hours,6 hours,12 hours,and 24 hours after surgery(P<0.05).The duration of the first pressure on the analgesic pump was prolonged(P<0.05)and the number of compressions was reduced(P<0.05).The incidence of postoperative nausea and vomiting was decreased(P<0.05).The incidence of cognitive impairment decreased at 1,3,and 5 days after surgery(P<0.05).Conclusion:ultrasound-guided TAPB can significantly reduce the postoperative pain score of elderly patients after laparoscopic surgery,reduce the occurrence of postoperative cognitive dysfunction,and can be used safely and effectively in laparoscopic radical gastrectomy for elderly patients,which is worthy of promotion and application.