Effect Of Transverse Abdominal Plane Block Combining With Coal-directed Fluid Therapy On Patients Undergoing Laparoscopic Surgery Of Lower Abdominal

Objective:To certify our hypothesis that transverse abdominal plane block guided with ultrasound could optimize the anesthesia in patients undergoing emergency surgery of lower abdominal managed by laparoscopy.Methodology:In this clinical research,total of forty cases（ASA I or II）,scheduled to practice laparoscopic surgery of lower abdominal（inguinal hernia repairs or appendectomies）under general anesthesia,were enrolled and randomly allocated to two groups of 20 cases/group:group TAP-G and group NTAP-G.All cases received goal-directed fluid therapy guided by NICOM after induction of anesthesia.Transverse abdominal plane block injections were performed with the guidance of ultrasound by a single practiced anesthesiologist,after induction of anesthesia.Participants in group TAP-G were given 0.5%Ropivacaine,whereas,these in group NTAP-G were given 0.9%NaCl as comparison.MAP,HR were noted at different time points（T₀ at the onset of the monitoring,T₁ after intubation,T₂at surgical incision,T3 after CO2 pneumoperitoneum established,T₄ at the conclusion of the procedure）.Arterial blood samples were obtained from radial approach at the time points of T₀ and T₄,subsequently,blood gas analyses were performed within 5 minutes to measure the concentrations of glucose and lactate,and the records were signed.The duration of the pneumoperitoneum and the surgical procedure,the consumption of propofol and sufentanil,the amount of fluid intake or output administered during the surgery were recored.The time to extubation,the VAS pain scores and the postoperative complications during the stay of postanesthesia care unit were evaluated and recorded.In addition,all cases were followed up,the time to gastrointestinal mobilization recovery and the time to mobilization were also noted.SPSS 22.0 was performed for the statistical analyses,P value<0.05 means statistically significant.Results:The concentration of lactate showed no difference whether between groups or among different time points in the same group.Glucose values at T₄ were higher than that of T₁（P<0.05）.Between groups,glucose values were lower in group TAP-G at T4（P<0.05）,while,comparable at T₁（P>0.05）.For comparison,the consumption of propofol and sufentanil was not as much as group NTAP-G（P<0.05）,During the stay of PACU,we found that group TAP-G got quicker extubation（P<0.05）,lower VAS scores for pain（P<0.05）,and less incidence of complications（P<0.05）.Besides,group TAP-G showed the same gastrointestinal mobilization recovery（P<0.05）.Comparing the hemodynamic parameters,HR of TAP-G group at T₂ AND T₃ was lower than that of group NTAP-G（P<0.05）.While,at other time points,neither HR nor MAP showed significant difference（P>0.05）.The amount of fluid intake and output administered during the surgery did not reveal any difference markedly between two groups（P>0.05）.Conclusions:Combining with general anesthesia,transverse abdominal plane block provided a preferable anesthesia protocol for the patients undergoing laparoscopic surgery of lower abdominal（inguinal hernia repairs or appendectomies）.