Pain, Postoperative, Regional Anaesthesia, Transversus Abdominis Plane Block (TAP Block)
Conditions
Keywords
Regional Anaesthesia, Transversus abdominis plane block (TAP block), Pain, Postoperative
Brief summary
Elderly patients undergoing minimally invasive gastrointestinal tumor surgery face complex postoperative pain management due to age-related physiological decline and surgical particularities, where traditional opioids are prone to adverse effects. Our study investigates the clinical analgesic efficacy of ultrasound-guided transversus abdominis plane block (TAPB) in these patients, focusing on analgesic quality, delirium incidence, opioid consumption, and postoperative recovery indicators. This evaluation aims to assess its clinical value and safety while providing evidence-based insights for optimizing perioperative analgesia protocols.
Detailed description
Globally, approximately 30% of surgical patients experience moderate to severe acute postoperative pain annually, with 11% developing severe acute postoperative pain. Inadequate pain control and analgesic administration may precipitate adverse outcomes such as postoperative delirium, a complication particularly prevalent in elderly populations. The concept of multimodal analgesia has emerged to enhance therapeutic efficacy, mitigate adverse effects associated with monotherapy, accelerate postoperative rehabilitation, and improve patient satisfaction. The transversus abdominis plane block constitutes a critical component of multimodal analgesic strategies. This randomized controlled trial was conducted to compare the differences in postoperative analgesic efficacy between the transversus abdominis plane block intervention group and the non-intervention control group among elderly patients undergoing minimally invasive gastrointestinal tumor surgery. Key evaluation parameters included postoperative pain intensity (assessed via validated pain scales), incidence of postoperative delirium, opioid consumption , and comprehensive postoperative recovery metrics (e.g., length of hospitalization). The study concurrently evaluated the clinical safety profile of transversus abdominis plane block through systematic monitoring of procedure-related complications and adverse events, thereby providing evidence-based data to refine perioperative analgesic protocols and optimize Enhanced Recovery After Surgery (ERAS) pathways in geriatric surgical populations.
Interventions
PROCEDURETransversus Abdominis Plane Block, TAPB
The procedure was performed by anesthesiologists with extensive expertise in nerve blockade techniques. For upper abdominal surgical incisions, a subcostal approach transversus abdominis plane block (TAPB) was implemented under ultrasound guidance to identify the transversus abdominis plane. A total of 20 mL of 0.33% ropivacaine hydrochloride injection (Naropin®) was incrementally administered, followed by contralateral application using identical techniques, with ultrasonographic confirmation of fusiform drug distribution within the transversus abdominis plane to achieve upper abdominal incision analgesia. For lower abdominal incisions, a lateral approach was employed, with the same dosage of local anesthetic injected at the target site and bilateral blocks performed after confirming fluid dispersion patterns under real-time ultrasound visualization.
Sponsors
Chinese PLA General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Elderly patients scheduled for elective minimally invasive gastrointestinal tumor surgery under general anesthesia 2. Age ≥65 years 3. American Society of Anesthesiologists (ASA) physical status classification ≤III 4. Body mass index (BMI) 18-30 kg/m²
Exclusion criteria
1. Allergy to anesthetic agents 2. Preoperative chronic pain or chronic use of opioids/nonsteroidal anti-inflammatory drugs (NSAIDs) 3. Contraindications to regional blockade:Local infection at puncture site , Coagulopathy (INR \>1.5, platelet count \<80×10⁹/L) 4. There is cognitive impairment, which is determined based on Mini Mental State Examination (MMSE) scores below the standard threshold 5. Preoperative neurological/psychiatric disorders:Consciousness alterations, Epilepsy, Alzheimer's disease, Parkinson's disease, Schizophrenia, Anxiety or depressive disorders, Hepatic, pulmonary, or renal encephalopathy 6. Recent stroke history 7. Postoperative admission to intensive care unit (ICU)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain score | 24 hours after surgery | Pain scores using Numerical Rating Scale (NRS). The Numerical Rating Scale (NRS) assesses pain intensity through patient self-reporting on an 11-point scale ranging from 0 (no pain) to 10 (worst pain imaginable). Patients independently select a single number reflecting their current pain level without clinician interpretation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| postoperative delirium during hospitalization | Postoperaitve Day 1-5 | The 3D-CAM (3-Minute Diagnostic Interview for CAM-defined Delirium) is a standardized rapid bedside assessment for delirium screening. It evaluates four core features: (1) Acute onset/fluctuating course, (2) Inattention, (3) Disorganized thinking, and (4) Altered level of consciousness. A positive delirium diagnosis requires: Feature 1 AND Feature 2 to be present concurrently, plus at least one of Feature 3 OR Feature 4. |
| consumption of sufentanil | During the operation | — |
| Subjective sleep quality score | The first postoperative day | Using the scaleRichards-Campbell Sleep Questionnaire (RCSQ) scale. The Richards-Campbell Sleep Questionnaire (RCSQ) is a patient-reported visual analog scale assessing sleep quality in critically ill patients. It evaluates five domains: sleep depth, sleep latency (ease of falling asleep), awakenings (frequency of disruption), sleep efficiency (returning to sleep), and overall sleep quality. Patients mark each item on a 100-mm line (0 = worst possible to 100 = best possible). The total score is the mean of all domains (range: 0-100), with higher scores indicating better sleep. Administration requires ≤3 minutes and is completed by alert patients upon waking. |
| pain score | 1, 6, and 48 hours after surgery | Resting and movement pain scores using Numerical Rating Scale (NRS). The Numerical Rating Scale (NRS) assesses pain intensity through patient self-reporting on an 11-point scale ranging from 0 (no pain) to 10 (worst pain imaginable). Patients independently select a single number reflecting their current pain level without clinician interpretation. |
| length of hospital stay | No more than 4 weeks | — |
| Patient satisfaction | From surgery to hospital discharge (up to 4 weeks). | Postoperative analgesia satisfaction is assessed using an 11-point Numerical Rating Scale (NRS), where 0 = completely dissatisfied and 10 = completely satisfied. |
| Adverse reactions: Dizziness, nausea and vomiting | Postoperative Day 1-5 | — |
| the use of a patient-controlled analgesia (PCA) pump | Three days after surgery | — |
Outcome results
None listed