Influence of intravenous general anesthesia combined with epidural anesthesia and with ultrasound-guided bilateral transversus abdominis plane on laparoscopic colorectal cancer patients

  Objective  To investigate the effects of intravenous general anesthesia combined with epidural anesthesia and with ultrasound-guided bilateral transversus abdominis plane (TAP) block on hemodynamics, stress level and agitation during recovery in patients with laparoscopic colorectal cancer surgery.

  Methods  A total of 102 patients undergoing laparoscopic colorectal cancer surgery were selected as research subjects, and were divided into combined anesthesia group (intravenous general anesthesia combined with epidural anesthesia), general anesthesia group (intravenous general anesthesia), and general anesthesia combined with TAP group(intravenous general anesthesia combined with TAP) by 1∶1 pairing according to the random number table method, with 34 cases in each group. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) at 10 min before induction of anesthesia (T₀), 30 min after induction of anesthesia (T₁), cessation of anesthesia (T₂) and 10 min after tracheal tube removal (T₃) were compared. The changes of angiotensin Ⅱ(AngⅡ), blood glucose, serum immunoglobulin (Ig) M and IgG before anesthesia, after the establishment of pneumoperitoneum and 24 h after surgery were evaluated. Eye opening time and agitation score were observed.

  Results  There were no significant differences in SBP, DBP and HR among the three groups at time point of T₀ (P>0.05); at T₁ and T₂, the SBP and DBP of the combined anesthesia group showed no statistically significant differences when compared with the general anesthesia group and the general anesthesia combined with TAP group (P < 0.05); there was no significant difference in HR among the three groups (P>0.05); at T₃, there were no significant differences in SBP, DBP and HR in the combined anesthesia group compared with the general anesthesia combined with TAP group and general anesthesia group (P>0.05). After skin incision and at the end of the operation, AngII and blood glucose in the combined anesthesia group were lower than those in the general anesthesia combined with TAP group and the general anesthesia group (P < 0.05); after the establishment of pneumoperitoneum and 24 hours after the operation, the IgM and IgG in the combined anesthesia group were higher than those in the general anesthesia group and the general anesthesia combined with TAP group (P < 0.05). The eye opening time was shorter, and agitation score was lower in the combined anesthesia group than those in the general anesthesia group and the general anesthesia combined with TAP group (P < 0.05).

  Conclusion  Intravenous general anesthesia combined with epidural anesthesia in laparoscopic colorectal cancer surgery is beneficial to stabilize hemodynamics, reduce stress levels, and avoid occurrence of postoperative agitation events.