Application of ultrasound-guided transverses abdominis plane block combined with general anesthesia in laparotomy of senile female patients

Abstract:

Objective：To explore the safety and effectiveness of transverses abdominis plane block combined with general anesthesia in senile female patients undergoing laparotomy. Methods：Sixty senile women diagnosed as benign diseases were recruited in the study according to certain criteria（ASAⅠ-Ⅲ）. The patients were randomly divided into Group C（30 cases） and Group TAP（30 cases）. The patients in Group C were treated with single general anesthesia during the induction and maintenance periods of anesthesia. The patients in Group TAP received TAP block as anesthesia induction and general anesthesia as maintenance. The mean arterial pressure（MAP），heart rate（HR），adrenaline（A） and noradrenaline（NA） level at the following time：before anesthesia induction（T0），after anesthesia induction（T1），skin incision（T2），suture abdominal cavity（T3），30 minutes after surgery（T4） were recorded. The VAS score，analgesic pump pressure times，the number of sufentanil reme－dies and adverse effects（including nausea，vomit，hypotension，bradycardia，uroschesis and traction reaction） were recorded at following time after surgery 2，4，8，12，24 hours. Results：Com－pared with MAP at T0[（122.8±7.0） mmHg] in Group C，MAP of T1[（111.7±9.4） mmHg]，T2[（102.2±8.0） mmHg]，T3[（101.1±11.9） mmHg] and T4[（105.0±5.3） mmHg] were decreased. Meanwhile the MAP of Group TAP at T1[（113.3±10.9） mmHg]，T2[（110.1±9.4） mmHg]，T3[（109.1±11.2） mmHg] and T4[（116.5±7.2） mmHg] were lower than that at T0[（121.3±9.3） mmHg]. However，during T2-T4，MAP of Group TAP was relatively stable than that of Group C. Additionally，compare with that of Group C，the adrenaline level in serum of Group TAP during T2-T4 [T2：（192.3±22.6） pg/mL，T3：（221.7±16.5） pg/mL，T4：（166.4±14.1） pg/mL] were lower，while noradrenaline level of serum in Group TAP[T2：（140.4±17.0） pg/mL，T3：（149.6±14.4） pg/mL，T4：（116.7±21.1） pg/mL] were also lower. Furthermore，the average VAS scores of Group TAP at 2-12 h after surgery（2 h：2.40±0.50，4 h：2.27±0.45，8 h：2.06±0.71，12 h：2.03±0.61） were lower. Additionally，analgesic pump pressure times[（15.3±4.1） times] and sufentanil remedies cases（3 cases） of group TAP were lower than that of Group C[（36.5±6.9） times，12 cases]. There was no difference between two groups at post-operation. Repeated-measures analysis of variance showed that MAP，HR，A，NA，and VAS at different times were different between the TAP and C groups after correction（P<0.05）. Furthermore，time and group factors of HR，A，NA，VAS were interacted（P<0.05）. Conclusion：Compared to single general anesthesia，ultrasound-guided TAP block combined with general anesthesia has better effect on maintaining stable hemodynamics，reducing stress reaction during operation and relieving post-operative pain on senile female patients undergoing laparotomy.