This study evaluates the effect of transversus abdominis plane(TAP) block combined with general anesthesia on perioperative stress response in patients undergoing radical gastrectomy. One third of participants will receive TAP block combined with general anesthesia, another one third of participants will receive epidural anesthesia combined with general anesthesia, while the rest will receive only general anesthesia.
Clinically, combining epidural with general anaesthesia may confer many advantages to patients undergoing major thoracic, abdominal or orthopaedic surgery. Epidural anaesthesia can attenuate sympathetic hyperactivity and the stress response, maintain bowel peristalsis, spare the use of opioids, and facilitate postoperative feeding and physiotherapy. However, establishing epidural anesthesia is not without risks and contraindications, including refusal by the patient, technical failure, unintentional dural puncture, waist and back pain and local anaesthetic toxicity. When neurologic complications do occur, the resulting morbidity and mortality is considerable. Transversus abdominis plane (TAP) block, is another new regional anesthesia technique, has been introduced as an abdominal wall block capable of providing effective analgesia, reducing opioid consumption, and lessening opioid-related side effects. In addition,TAP block, somewhat as a pre-emptive analgesia approach, is a way of pain intervention before noxious stimulation which has been reported to be potent to attenuate the stress response. Although the analgesia efficiency of TAP block has been widely studied, its effectiveness to suppress stress response has little comparison with classic epidural block and general anesthesia. Unlike epidural anaesthesia, TAP block is easy to administer and lower incidence for side-effects.The investigators hypothesize that the TAP block reduces the stress response of surgery to the similar extent to epidural anaesthesia when combined with a standard general anaesthesia for abdominal surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
91
Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.
Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.
The Control group receives standard IV-inhaled general anesthesia.
China-Japan Union Hospital of Jilin University
Changchun, Jilin, China
Physiological Parameters: Plasma Concentration of Norepinephrine (NE)
Venous blood samples will be collected at certain time points. The blood samples are collected in a pre-chilled tubes in ice and are centrifuged within 90min, and then separated plasma are stored at -80°C until analysis. The NE levels are measured by ELISA kits.
Time frame: up to 48h after surgery
Physiological Parameters: Plasma Concentration of Epinephrine (E)
Venous blood samples will be collected at certain time points. The blood samples are collected in a pre-chilled tubes in ice and are centrifuged within 90min, and then separated plasma are stored at -80°C until analysis. The E levels are measured by ELISA kits.
Time frame: up to 48h after surgery
Physiological Parameters: Plasma Concentration of Cortisol (Cor)
Venous blood samples will be collected at certain time points. The blood samples are collected in a pre-chilled tubes in ice and are centrifuged within 90min, and then separated plasma are stored at -80°C until analysis. The Cor levels are measured by ELISA kits.
Time frame: up to 48h after surgery
Physiological Parameters: Plasma Concentration of Glucose (Glu)
When venous blood are collected, glucose levels are measured immediately by Glucometer.
Time frame: up to 48h after surgery
Hemodynamic Parameters: Heart Rate.
Continuous monitoring of heart rate to 48 hours after surgery.
Time frame: up to 48h after surgery
Hemodynamic Parameters: Mean Arterial Pressure(MAP)
Continuous monitoring of mean arterial pressure(MAP) to 48 hours after surgery. mean arterial pressure(MAP)＝ (systolic blood pressure＋2×diastolic blood pressure)/3
Time frame: up to 48h after surgery
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Anesthetics Consumption: Sufentanil Consumption
Intraoperative superaddition of sufentanil was measured.
Time frame: during operation
Questionnaire: Pain Scores at Rest
Pain scores of the participants will be measured by the Visual Analogue Scale. Measurement of VAS: Draw a 10cm horizontal line on the paper. The VAS were anchored at 0cm(no pain) and 10cm(worst possible pain), the middle part shows varying degrees of pain, the greater of the number, the worse of the pain.
Time frame: 1hr, 6hr, 12hr, 24hr, and 48hr after surgery
Questionnaire: Pain Scores on Movement
Pain scores of the participants will be measured by the Visual Analogue Scale. Measurement of VAS: Draw a 10cm horizontal line on the paper. The VAS were anchored at 0cm(no pain) and 10cm(worst possible pain), the middle part shows varying degrees of pain, the greater of the number, the worse of the pain.
Time frame: 1hr, 6hr, 12hr, 24hr, and 48hr after surgery
Anesthesia Recovery: the Time of First Flatus
The time of first flatus was measured after surgery.
Time frame: Through study completion, an average of 2 weeks
Anesthesia Recovery: Number of Participants With Prolonged Hospitalization
The percentage of long hospitalization were measured. More than 7 days after surgery is defined as prolonged hospitalization.
Time frame: Through study completion, an average of 2 weeks
Side Effects: Number of Participants With Sedation
The state of sedation was evaluated after surgery during first postoperative 48 hours.
Time frame: up to 48h after surgery
Side Effects: Number of Participants With Nausea
The state of nausea was evaluated after surgery during first postoperative 48 hours.
Time frame: up to 48h after surgery
Side Effects: Number of Participants With Vomiting
The state of vomiting was evaluated after surgery during first postoperative 48 hours.
Time frame: up to 48h after surgery