General anesthesia combined subcostal transversus abdominis plane (TAP)or rectus sheath block (RSB)can significantly reduce the use of opiates in minimally invasive surgery.However, similar reduction was not observed in open abdominal surgery during perioperative period.Therefore, the investigators should try to improve the blocking methods to reduce the side effects of a large number of opiates. Based on the range and its analgesic effect of various nerve block is obviously related to the injection site of local anesthetics, this randomized controlled study hypothesized that modified RSB under the guidance of surgical incision may be more effective in inhibiting the harmful stimulation of surgery.
For abdominal cancer surgery with midline incision, subcostal transversus abdominis plane or rectus sheath block combined with general anesthesia was more effective in reducing pain scores and opioid consumption compared with general anesthesia alone. However, there was no statistically significant difference in supplementary fentanyl during operation. Besides adequate pain relief around incisions, blunting visceral traction response has also an important role in hemodynamic stability.With the evidences for a potential mechanism for the antinociceptive effects of propofol on visceral nociception and dexmedetomidine combined with oxycodone can provide good visceral analgesia, the investigators supposed that visceral nociception was well suppressed by adequate antinociceptive drugs. The propofol combination with dexmedetomidine may had significant effect on the reduction of the sympathoadrenergic tone with decrease of blood pressure and heart rate.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
126
Subcostal transversus abdominis plane block
Rectus Sheath Block under the guidance of surgical incision
Traditional general anesthesia management
The First Affiliated Hospital of Anhui Medical University
Hefei, Anhui, China
Opiate consumption
Remifentanil consumption
Time frame: From the beginning to the end of anesthesia,up to 6 hours.
Tumor recurrence rate
Tumor recurrence rate after surgery
Time frame: 1-year after surgery
Opiate consumption
Sufentanil consumption
Time frame: From the end of anesthesia to 48 hours after surgery, up to 2 days.
Pain scores
1. Through visual analogue scale (from 0 to 10) to assess the degree of pain; 2. The number 0 means no pain and the number 10 means the most pain; 3. Patients with visual analogue scale greater than 3 points should have remedial analgesic drugs.
Time frame: 2 hours after surgery
Pain scores
1. Through visual analogue scale (from 0 to 10) to assess the degree of pain; 2. The number 0 means no pain and the number 10 means the most pain; 3. Patients with visual analogue scale greater than 3 points should have remedial analgesic drugs.
Time frame: 6 hours after surgery
Pain scores
1. Through visual analogue scale (from 0 to 10) to assess the degree of pain; 2. The number 0 means no pain and the number 10 means the most pain; 3. Patients with visual analogue scale greater than 3 points should have remedial analgesic drugs.
Time frame: 12 hours after surgery
Pain scores
1. Through visual analogue scale (from 0 to 10) to assess the degree of pain; 2. The number 0 means no pain and the number 10 means the most pain; 3. Patients with visual analogue scale greater than 3 points should have remedial analgesic drugs.
Time frame: 24 hours after surgery
Pain scores
1. Through visual analogue scale (from 0 to 10) to assess the degree of pain; 2. The number 0 means no pain and the number 10 means the most pain; 3. Patients with visual analogue scale greater than 3 points should have remedial analgesic drugs.
Time frame: 36 hours after surgery
Pain scores
1. Through visual analogue scale (from 0 to 10) to assess the degree of pain; 2. The number 0 means no pain and the number 10 means the most pain; 3. Patients with visual analogue scale greater than 3 points should have remedial analgesic drugs.
Time frame: 48 hours after surgery
Time for first to press pump
Time for first to press pump
Time frame: Up to 2 days after surgery
Time of anal exsufflation
Time for first anal exsufflation
Time frame: Up to 7 days after surgery
Delirium
Incidence of postoperative delirium
Time frame: Up to 7 days after surgery
The occurrence of nausea and vomiting
Incidence of nausea and vomiting
Time frame: Up to 7 days after surgery
The occurrence of cardiovascular or cerebrovascular events
Incidence of cardiovascular or cerebrovascular adverse events
Time frame: From the end of surgery to the time the patients discharge, up to 1 month.
Length of hospital stay
Length of hospital stay
Time frame: From the end of surgery to the time the patients discharge, up to 1 month.
Mortality
Mortality after surgery
Time frame: 30-day after surgery
Mortality
Mortality after surgery
Time frame: 1-year after surgery
Concentration of norepinephrine
Concentration of norepinephrine during surgery
Time frame: Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity.
Concentration of epinephrine
Concentration of epinephrine during surgery
Time frame: Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity.
Concentration of cortisol
Concentration of cortisol during surgery
Time frame: Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity.
Concentration of tumor necrosis factor-α
Concentration of tumor necrosis factor-α during surgery
Time frame: Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity.
Concentration of interleukin-6
Concentration of interleukin-6 during surgery
Time frame: Time before anesthesia induction,immediately after incision,celiac exploration and immediately after closing the abdominal cavity.
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