The Combination Of General Anesthesia And Transverse Abdominis Plane Block Influence Postoperative Pain And Cognition Of Obesity Patients Undergoing Laparoscopic Sleeve Gastrectomy Surgery

Objective To investigate the influence of modified general anesthesia and transverse abdominis plane block on the pain management and cognition of obesity patient undergoing laparoscopic sleeve gastrectomy surgery.Methods Eighty patients aged 18-65 years,each with an American Society of Anesthesiologists（ASA）physical status I-II,and with a Body Mass Index（BMI）greater than 40 kg/m² or greater than 35 kg/m² with a concomitant disease,scheduled for laparoscopic sleeve gastrectomy surgery from 2018 November to 2019 December were enrolled.They were randomly divided into two groups:general anesthesia group（GA）and general anesthesia combining transverse abdominis plane block group（GA+TAPB）.Bolus dosage of dexmedetomidine was infused at 2μg·kg^-1·h^-1 for 15min after patients entering the operating room and peripheral veins were punctured.Then anesthesia induction was performed with propofol,remifentanil and cis-atracurium,followed by sevoflurane and intravenous drugs for the entire surgery.Patient controlled intravenous analgesia was applied immediately after the surgery accomplished.TAPB was performed under ultrasound guidance and the block effect was tested before induction of anesthesia.Heart rate（HR）,arterial blood pressure（ABP）and pulse Oxygen Saturation（Sp O₂）were recorded at time T₀（15min after entering the operating room）,T₁（after pneumoperitoneum established）,T₂（after gastrectomy）and T₃（after tracheal tube extracted）.Hamilton Anxiety Scale（HAM-A）,Hamilton Depression Scale（HAM-D）,Mo CA Scale（Mo CA）and auditory vocabulary learning scale（AVLT）were used to evaluate the psychological state and cognitive function of patient before and three months after surgery.Visual analgesic scale（VAS）was applied to evaluate the postoperative pain management and the recovery.Results1.Epidemiological characteristicsThere was no difference in epidemiological characteristics（including age,gender ratio,height,weight,BMI,anesthesia time and operative time）of patients in two groups（P>0.05）.2.Hemodynamics parameterAt the time point T₀,there was no statistically significant difference in GA and GA+TAPB groups of HR,MAP,and Sp O₂（P>0.05）;At the time point T₁-T₃,compared with GA group,HR and MAP was significantly decreased in GA+TAPB group（P<0.05）;There was no statistically significant difference in both groups of the anesthesia and operation time（P>0.05）.3.Dosage of intravenous general anestheticThe intraoperative dosage of propofol and remifentanil in GA+TAPB group was significantly lower comparing with GA group（P<0.05）.4.The postoperative VAS value.At the time point T₄-T₆ and D₁-D₂,patients in group GA+TAPB showed significantly lower VAS value than in group GA（P<0.05）.5.Additional usage of analgesic agents.Also,the additional usage of analgesic agents in the postoperative period was significantly less in the GA+TAPB group than GA group（P<0.05）.There was no significant difference in the times of effective of PCIA pressing between the two groups.6.Psychological state and cognitive functionPre-operative performance of patients in both groups of HAM-A,HAM-D,Mo CA and AVLT scale no significant difference（P>0.05）.But The majority of obesity patients reported possible to mild anxiety or depression before surgery,but 3months following LSG,mental status was apparently improved.And 3 months following LSG,MOCA and AVLT scale value of patients in GA+TAPB group were higher than in GA group（P<0.05）.Conclusion The combination of general anesthesia and TAPB could provide more stable anesthesia and better postoperative pain management,and may also have positive effect on the cognitive function and instantaneous delay memory of obesity patients.