Lin Qing-Song, Lin Xian-Zhong
1 Anesthesiology Department, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
2 Neurosurgery Department, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
J Int Med Res. 2018 Nov;46(11):4437-4446. doi: 10.1177/0300060518790699. Epub 2018 Aug 15.
The transversus abdominis plane (TAP) block ameliorates visual analogue scale scores and decreases morphine requirements, but its role remains unclear. Patients of advanced age are susceptible to local anesthetic intoxication. We aimed to identify an optimal concentration that can be used in enhanced recovery after surgery (ERAS) without compromising analgesic efficacy.
In total, 120 patients aged ≥65 years undergoing laparoscopic rectal cancer surgery received general anesthesia combined with a TAP block using 0.25% ropivacaine (Group A), 0.50% ropivacaine (Group B), or 0.75% ropivacaine (Group C) in a 40-mL volume. Group D only received general anesthesia. Epinephrine, plasma cortisol, interleukin-6, and tumor necrosis factor-α were measured at baseline, skin incision, celiac exploration, and tracheal extubation. The proportions of CD4 and CD4/CD8 cells were measured at baseline and postoperative days 1 and 3.
The TAP block relieved the stress response and accelerated intestinal functional recovery as shown by significant reductions in VAS scores and anesthetic requirements. However, there was no significant difference between Groups B and C.
The TAP block plays an important role in ERAS in older patients undergoing laparoscopic rectal cancer surgery, and 0.5% ropivacaine is an optimal concentration that can reduce toxicity without undermining analgesia.
腹横肌平面（TAP）阻滞可改善视觉模拟评分并减少吗啡用量，但其作用仍不明确。老年患者易发生局麻药中毒。我们旨在确定一种在不影响镇痛效果的情况下可用于术后加速康复（ERAS）的最佳浓度。
总共120例年龄≥65岁的接受腹腔镜直肠癌手术的患者接受全身麻醉，并分别接受40毫升容积的0.25%罗哌卡因（A组）、0.50%罗哌卡因（B组）或0.75%罗哌卡因（C组）的TAP阻滞。D组仅接受全身麻醉。在基线、皮肤切开、腹腔探查和气管拔管时测量肾上腺素、血浆皮质醇、白细胞介素-6和肿瘤坏死因子-α。在基线以及术后第1天和第3天测量CD4和CD4/CD8细胞的比例。
TAP阻滞减轻了应激反应并加速了肠道功能恢复，表现为VAS评分和麻醉需求显著降低。然而，B组和C组之间没有显著差异。
TAP阻滞在老年腹腔镜直肠癌手术患者的ERAS中起重要作用，0.5%罗哌卡因是一种可降低毒性且不影响镇痛效果的最佳浓度。
