| Objective :To investigate the effect of ultrasound-guided bilateral dual transverse abdominis plane（BD-TAP）block on muscle-relaxing effect,intraoperative respiratory mechanics,surgical conditions and postoperative pulmonary complications in elderly individuals undergoing laparoscopic radical resection of rectal cancer under general anesthesia.Method: According to the random number table,60 patients（aged 65 ～ 80 years,ASA grade I～III,BMI 18～ 30 kg/ m2）scheduled for laparoscopic radical resection of rectal cancer under general anesthesia were assigned to undergo BD-TAP block with ropivacaine（group BD-TAP n=30）and versus control group with normal saline（group GA n=30）.Ultrasound-guided bilateral Subcostal TAP block and bilateral lateral TAP block were administered in the preanesthesia room,group BD-TAP received TAP block using 0.25% ropivacaine,15 ml per point,while group GA received equivalent normal saline.Before regional anesthesia（t1）,30 min after regional anesthesia（t2）and 30 min after tracheal extubation（t8）,the thickness of external oblique muscle,internal oblique muscle and transversus abdominis muscle were measured by ultrasound at relaxation state and maximum cough in 2 groups.Both groups received lung-protective ventilation with a tidal volume of 7 ml/kg predicted body weight,positive end-expiratory pressure（PEEP）of 5 cm H2O and intermittent lung recruitment manoeuvres.The Ppeak,Pplat and driving pressure was compared between the two groups at five time points: 5 min after endotracheal intubation（t3）、5 min after establishment of the pneumoperitoneum（t4）、5min after trendelenberg position（t5）、60 min after trendelenberg position（t6）and 5 min after bed returned to level 0° with the pneumoperitoneum released（t7）.The surgical conditions and the incidence of postoperative pulmonary complications（PPC）within 7days after surgery was observed.Results: There were no significant differences in gender,age,height,weight,predicted body weight,body mass index,ASA grade,previous medical history,type of surgery,anesthesia time,operation time,intraoperative muscle relaxant dosage,intraoperative infusion volume,blood loss,urine volume and ARISCAT respiratory risk score between the two groups（P>0.05）.The thickness of external oblique muscle,internal oblique muscle and transversus abdominis muscle were no statistically significant differences in relaxation state and maximum cough at t1 between 2 groups（P>0.05）.Compared with GA group,thickness of internal oblique muscle and transverse abdominis muscle at t2 and t8 maximum cough in BD-TAP group was significantly lower than that in GA group,the difference was statistically significant（P<0.05）.Intra-group comparison,compared with relaxation state,the thickness of internal oblique muscle and transverse abdominis muscle at t1 time point of maximum cough was significantly increased in BD-TAP group,and the difference was statistically significant（P<0.05）,while the thickness of internal oblique muscle and transverse abdominis muscle at t2 and t8 time point of maximum cough was not significantly different（P>0.05）.Compared with GA group,the Ppeak,Pplat and driving pressure of BD-TAP group were significantly lower than those of GA group at t4,t5 and t6 time points（P < 0.05）,but there was no significant difference at t3 and t7 time points（P > 0.05）.The percentage of patients maintaining a optimal condition was higher in the BD-TAP group,the difference was statistically significant（P < 0.05）.The incidence of pulmonary complications within 7 days after surgery in BD-TAP group was significantly lower than that in GA group（P < 0.05）.Conclusion: BD-TAP block can induce muscle relaxation in the external abdominal wall,reduce Ppeak,Pplat and driving pressure during pneumoperitoneum and trendelenberg position in patients undergoing laparoscopic radical resection of rectal cancer under general anesthesia,provided a more satisfactory surgical field condition,and reduce the incidence of pulmonary complications within 7 days after surgery. |
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