Effects Of Transversus Abdominis Plane Block On Postoperative Cognitive Function In Patients Undergoing Gastrointestinal Cancerradical Surgery

ObjectiveThe objective of this study was to to investigate the effect of transverse abdominis plane block combined with general anesthesia on postoperative cognitive function in patients undergoing laparoscopic radical resection of gastrointestinal tumors.It is expected to find a more appropriate anesthesia and analgesia method for these patients and provide a new perspective for the prevention and treatment of postoperative cognitive dysfunction.MethodsA total of 90 patients were selected who were undergoing laparoscopic radical resection of gastrointestinal tumors under general anesthesia in The Second People Hospital of YiBin.The operation time was over 120 minutes,the age was over 18 years old,ASA I-III.The patients were divided into TAP group and control group by random number table,45 cases in each.After induction,the patients in TAP group underwent ultrasound-guided bilateral TAP block before surgery.The subcostal incision approach was adopted in patients under going radical gastrectomy while the lateral approach was adopted in patients undergoing colorectal cancer radical surgery.20 ml of 0.375%ropivacaine was injected into each side.Patients in control group received total intravenous anesthesia alone..Both groups were connected with PCIA after operation.MAP and HR were recorded at the time before induction of anesthesia,skin incision,5 minutes before extubation and 15 minutes after extubation.Mini-mental State Examination(MMSE)and the scale of Confusion Assessment Method(CAM)were used to assess the cognitive function of patients 1 day before operation,1 day,3days,7 days after operation,the day of discharge,30 days after operation,and assess the occurrence of delirium 1-7 days after operation.Visual analogue scale(VAS)was used to assess the degree of pain.The incidence of PONV,the duration time of operation and anesthesia,the volume of blood loss and fluid input,consumption of anesthetic were recorded.ResultsThere was no significant difference in MMSE score 1d before operation,operation and anesthesia time,the volume of blood loss and fluid input between the two groups.Compared with the control group,MAP and HR decreased in TAP group at the time of skin incision,5 minutes before extubation and 15 minutes after extubation(P<0.05).In addition,The time of withdrawal-blinking,withdrawal-recovery in the TAP group were shorter than the control group(P<0.05)and The VAS score was decreased after operation(P < 0.05).The consumption of sufentanil,remifentanil and propofol was significantly reduced in the TAP group(P<0.05),besides the incidence of POCD and POD in 1 day after operation,the number of PONV was significantly decreased(P<0.05).Conclusion1.Preoperative TAP block can effectively reduce the incidence of POCD and POD1 day after laparoscopic radical resection of gastrointestinal tumors,which may be related to the reduction of intraoperative propofol and opioid analgesic dosage by TAP block and the provision of effective early postoperative analgesia.2.Preoperative TAP block can shorten the recovery time of anesthesia and provide effective postoperative analgesia early after operation.3.Preoperative TAP block is helpful to achieve more stable hemodynamics during the recovery period of anesthesia,and to reduce the occurrence of postoperative nausea and vomiting.