Comparison of effects of transversus abdominis plane block and thoracic epidural anesthesia mediated activation of inflammasome on postoperative medication, pain, and recovery in patients undergoing laparoscopic colorectal surgery

Abstract

Objective: This work was developed to compare the effects of transversus abdominis plane block (TAPB) and thoracic epidural anesthesia (TEA) mediated activation of inflammasome on postoperative medication, pain, and recovery in patients undergoing laparoscopic colorectal surgery. Then, the effects of two anesthesia methods on postoperative analgesia of patients were investigated and compared, aiming to provide reference for the selection of postoperative analgesia methods of laparoscopy.

Patients and methods: In this work, patients undergoing laparoscopic colorectal surgery were rolled into a TAPB group (30 patients) and a TEA group (30 patients). The blood pressure and stress indexes of the patients at different time points were observed and compared, and the doses of anesthetic drugs were recorded. Postoperative pain scores were evaluated, and postoperative recovery of the two groups was compared. Meanwhile, the peripheral venous bloods were extracted from the two groups before and after surgery for the determination of inflammasome proteins, and the detection results were compared.

Results: Data showed that the dose of sufentanil in TEA group was notably inferior to that in TAPB group (p<0.05). The blood pressure indexes in the TEA group decreased remarkably (p<0.05), while their changes in the TAPB group were stable. The slower point heart rate (HR), lower mean arterial pressure (MAP), and lower levels of cortisol (Cor) and norepinephrine (NE) in the TEA group were found when compared with the TAPB group during the period from pneumoperitoneum establishment to post-ventilation. After pneumoperitoneum establishment, blood oxygen saturation (SpO2) in the TEA group was lower than that in the TAPB group at the same time point (p<0.05). The postoperative visual analog scales (VAS) score and numerical rating scale (NRS) score in TEA group were lower than those in TAPB group (p<0.05). After surgery, the protein level in TEA group was significantly lower than that in TAPB group (p<0.05).

Conclusions: In short, the activation of inflammasome mediated by TEA could reduce the anesthetic agents used after laparoscopic colorectal cancer surgery and reduce the surgical stress response. In addition, TEA exerted a little effect on early immunity, which was safe and feasible, contributing to postoperative analgesia and recovery. In addition, its application value in laparoscopic postoperative analgesia was higher than TAPB.