Published online Oct 27, 2023. doi: 10.4240/wjgs.v15.i10.2171
Peer-review started: June 14, 2023
First decision: July 3, 2023
Revised: July 21, 2023
Accepted: August 21, 2023
Article in press: August 21, 2023
Published online: October 27, 2023
Postoperative complications are important factors affecting the survival time and quality of life of patients undergoing radical gastrectomy. Choosing an ideal anesthesia and analgesia program is of great significance for ensuring good surgical effect and reducing the incidence of postoperative complications. Although patient-controlled intravenous analgesia (PCIA) can control the outbreak of pain in time, opioids can easily cause adverse reactions such as nausea, vomiting, and respiratory depression. Epidural anesthesia combined with general anesthesia is commonly used in abdominal surgery, and ultrasound-guided transversus abdominal plane block (TAPB) is also effective in reducing postoperative pain and reducing the amount of analgesic drugs required. At present, there are few reports on the application of these two schemes in radical gastrectomy.
PCIA has been the most frequently used analgesic regimen in laparoscopic surgery in the past. Although it can control the outbreak of pain in time through the impact dose, the opioids used can easily cause adverse reactions, such as nausea, vomiting, and respiratory depression, which are not conducive to the postoperative rehabilitation of patients. It is thus necessary to optimize the anesthesia and analgesia program. By comparing the effects of epidural anesthesia and TAPB on the incidence of postoperative cognitive dysfunction (POCD), intestinal barrier function, and postoperative recovery quality in patients with laparoscopic gastric cancer, we can gather data that should be helpful when choosing the most suitable anesthesia and analgesia scheme for clinical practice.
The main goal was to select a more appropriate surgical anesthesia/analgesia program for patients with gastric cancer. Multimodal analgesia can prevent the introduction of pain stimulation from many sources and thereby block the transmission of pain signals and improve postoperative rehabilitation. By comparing the effects of epidural anesthesia and TAPB on postoperative recovery quality and complications in patients with laparoscopic gastric cancer, we may find ways to reduce the need to apply opioids during perioperative period and accelerate postoperative rehabilitation.
This was a retrospective study in which differences in postoperative pain, cognitive function, intestinal barrier function index, and incidences of agitation were observed between an epidural anesthesia group and an ultrasound-guided bilateral transversus abdominis plane block group. Cognitive dysfunction is one of the most common complications in patients undergoing laparoscopic gastric cancer surgery, and intestinal barrier function is an important indicator affecting postoperative intestinal peristalsis and recovery speed. By observing these indicators, we can obtain good reference data for future research.
Compared with patients in the epidural anesthesia group, patients in the ultrasound-guided TAPB group had less postoperative pain; significantly lower incidences of cognitive dysfunction, emergence agitation, and postoperative complications; and greater improvements in intestinal barrier function. The differences in the above indicators were statistically significant. However, the effects of the two anesthesia methods on the intraoperative vital signs of patients need to be further explored.
In contrast to previous studies, this study used retrospective analysis to explore and compare the effects of epidural anesthesia and TAPB on cognitive dysfunction, intestinal barrier function, and postoperative recovery quality in patients with laparoscopic gastric cancer. It was concluded that, compared with epidural anesthesia combined with general anesthesia, TAPB combined with general anesthesia had a good analgesic effect in laparoscopic gastric cancer surgery patients. TAPB combined with general anesthesia helped to reduce the incidence of postoperative cognitive dysfunction, and the emergence agitation and concurrent tension, and had a good effect on improving the quality of postoperative recovery.
Because this study was a retrospective analysis, the effects of the two anesthesia/analgesia regimens on the vital signs of a large sample of patients with gastric cancer needs to be analyzed in a prospective study.