Effect of transverse abdominis plane block on GluER,LacPR and cerebral oxygen metabolism indicators in elderly patients undergoing laparoscopic cholecystectomy
Objective To study the effects of transverse abdominis plane(TAP)block on glucose uptake rate(GluER),brain lactate production rate(LacPR)and cerebral oxygen metabolism in elderly patients undergoing laparoscopic cholecystectomy.Methods From June 2021 to June 2023,140 elderly patients undergoing laparoscopic cholecystectomy in the Sixth People's Hospital of Hengshui were randomly assigned into the general anesthesia group(70 cases,tracheal intubation general anesthesia)and TAP block combination group(70 cases,TAP block combined with general anesthesia).Patients in both groups were observed until 72h after operation.The dosage of anesthetic drugs,recovery and adverse events during the observation period in the two groups were analyzed.Vital signs,GluER,LacPR,cerebral oxygen metabolism indicators and inflammatory stress indicators at the time points of entering the operation room,tracheal intubation,pneumoperitoneum establishment,and the end of operation were compared between the two groups.Results The dosages of propofol and sufentanil in the TAP block combination group were significantly lower,and the recovery time of spontaneous respiration,recovery time and head-lifting time were significantly shorter than those of the general anesthesia group(P＜0.05).In the general anesthesia group,heart rate(HR)at the time points of tracheal intubation,pneumoperitoneum establishment and end of operation was significantly higher than that at the time point of entering the operation room(P＜0.05).HR at the time points of tracheal intubation,pneumoperitoneum establishment and end of operation was significantly lower in the TAP block combination group than that of general anesthesia group(P＜0.05).In the TAP block combination group,the mean arterial pressure(MAP)at the time points of tracheal intubation,pneumoperitoneum establishment and end of operation was significantly lower than that at the time point of entering the operation room(P＜0.05).MAP in the TAP block combination group at the time point of pneumoperitoneum establishment was significantly lower than that at the time points of tracheal intubation and end of operation(P＜0.05).In the general anesthesia group,MAP decreased and then increased from entering the operation room,to tracheal intubation,pneumoperitoneum establishment and end of operation,with a significant difference at varied time points(P＜0.05).MAP at the time points of tracheal intubation and pneumoperitoneum establishment was significantly higher in the TAP block combination group than that of general anesthesia group(P＜0.05).In the general anesthesia group,GluER and LacPR were significantly lower at the time points of tracheal intubation,pneumoperitoneum establishment and end of operation than those at the time point of entering the operation room(P＜0.05).They were significantly lower in the general anesthesia group than TAP block combination group(P＜0.05).In the TAP block combination group,jugular venous oxygen saturation(SjvO2)at the time points of tracheal intubation,pneumoperitoneum establishment and end of operation was significantly higher than that at the time point of entering the operation room(P＜0.05),and it was significantly higher than the general anesthesia group(P＜0.05).The arteriovenous O2 content difference(Da-jvO2)in the TAP block combination group at the time points of tracheal intubation,pneumoperitoneum establishment and end of operation was significantly lower than that at the time point of entering the operation room(P＜0.05),and it was significantly lower than the general anesthesia group(P＜0.05).Serum C-reactive protein(CRP),interleukin-6(IL-6),aldosterone(RAA)and renin(REN)in the two groups at the end of operation were significantly higher than those at the time point of entering the operation room,and they were significantly lower in the TAP block combination group than general anesthesia group(P＜0.05).During the observation period,the overall incidence of adverse events was significantly lower in the TAP block combination group than that of the general anesthesia group(P＜0.05).Conclusion TAP block effectively reduces the intraoperative anesthetic drug dosage in elderly patients with laparoscopic cholecystectomy,stabilizes vital signs,improves GluER,LacPR,and cerebral oxygen metabolism,and reduces inflammation and stress response.It contributes to the postoperative recovery,and effectively reduces the occurrence of adverse events.
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