Transverse Abdominal Plane Block Combined With Rectus Sheath Block Versus Epidural Anesthesia For Upper Abdominal Surgery Comparison Of Postoperative Analgesia

Objective:At present,it is not clear about the comparison of the analgesic effect of transversus abdominis plane（TAP）block combined with rectus sheath（RS）block and epidural block after upper abdominal surgery.In order to further clarify the analgesic effect of TAP+RS block after upper abdominal surgery,this study observed the feasibility and safety of its clinical application,and compared the two analgesic methods in order to provide more choices and perfect analgesic schemes for upper abdominal surgery.Methods:90 patients who are going to undergo Laparoscopic-assisted resection of gastric stromal tumor and radical gastrectomy under general anesthesia were randomly divided into three groups according to the ratio of 1:1:1,epidural group（group E）,ropivacaine TAP+RS group（group TL）,and bupivacaine TAP+RS group（group TB）.Patients in group E received thoracic segment(T_9-10)epidural block.Patients in TL group were treated with 0.375%ropivacaine for bilateral TAP block combined with RS block.Patients in TB group were treated with 0.25%bupivacaine for bilateral TAP block combined with RS block;Patients were treated with 1μg/ml sufentanil Self-controlled invasive analgesia after operation.Main outcome measures:Visual Analogue Score（VAS）the time of pressing analgesia pump for the first time and the amount of sufentanil used after operation were recorded at 1 h,6 h,12 h,24h and 48 h after operation.The secondary observation outcome recorded the times when the average arterial pressure was less than 60mm Hg during operation,the time of getting out of bed for the first time,the time of anal exhaust,the time of removing catheter,the postoperative hospital stay,the adverse reactions such as nausea and vomiting within 48 hours after operation,the levels of Interleukin-6（IL-6）,Tumor necrosis factor-α（TNF-α）before and after operation,and the Mini-Mental State Examination（MMSE）score before and after operation.Results:Finally,87 patients were included in this experiment,including 28 patients in E group,29 patients in TL group and 30 patients in TB group.There was no statistical difference in the VAS scores of the three groups at 1 hours,6 hours,12 hours,24 hours and 48 hours after operation（P>0.05）.Compared with group E,the time for patients in TL group and TB group to press the analgesia pump for the first time was longer,with statistical significance（P<0.05）.The time to press the analgesia pump for the first time in TB group was longer than that in TL group,and the difference was statistically significant（P<0.05）.There was no statistical difference in the amount of sufentanil used in postoperative analgesia pump among the three groups（P>0.05）.Compared with group E,the incidence of nausea,vomiting and itching in the other two groups decreased within 48 hours after operation,with statistical significance（P<0.05）,but there was no statistical difference between TB group and TL group（P>0.05）.There was no significant difference in postoperative hospital stay among the three groups（P>0.05）.Compared with group E,the time of removing urinary catheter,getting out of bed for the first time and anal exhaust in the other two groups were shorter,with statistical significance（P<0.05）,but there was no statistical difference between TB group and TL group（P>0.05）.The incidence of intraoperative hypotension in group E was higher than that in other two groups,and the difference was statistically significant（P<0.05）,but there was no statistical difference between TB group and TL group（P>0.05）.There was no statistical difference in serum concentrations of IL-6 and TNF-αamong the three groups before operation（P>0.05）.There was no statistical difference in serum concentrations of IL-6 and TNF-αamong the three groups at 24 hours after operation（P>0.05）.No postoperative cognitive dysfunction occurred in 87 patients in this experiment.ConclusionSummary of this study,using TAP+RS block in postoperative analgesia after upper abdominal surgery can provide similar analgesic effect as epidural analgesia,and the former has lower incidence of hypotension,postoperative nausea and vomiting and itching,which is more conducive to patients’rapid recovery;At the same time,the analgesic effect of bupivacaine in TAP+RS block is better than that of ropivacaine,which can provide a longer analgesic effect.Therefore,ultrasound-guided TAP+RS block can be safely used for postoperative analgesia in upper abdominal surgery.