Transversus Abdominis Plane Block on Stress Response
Condition: Gastrostomy
Study type: Interventional

Summary: 
      This study evaluates the effect of transversus abdominis plane(TAP) block combined with
      general anesthesia on perioperative stress response in patients undergoing radical
      gastrectomy. One third of participants will receive TAP block combined with general
      anesthesia, another one third of participants will receive epidural anesthesia combined with
      general anesthesia, while the rest will receive only general anesthesia.
    

Detailed description: 
      Clinically, combining epidural with general anaesthesia may confer many advantages to
      patients undergoing major thoracic, abdominal or orthopaedic surgery. Epidural anaesthesia
      can attenuate sympathetic hyperactivity and the stress response, maintain bowel peristalsis,
      spare the use of opioids, and facilitate postoperative feeding and physiotherapy. However,
      establishing epidural anesthesia is not without risks and contraindications, including
      refusal by the patient, technical failure, unintentional dural puncture, waist and back pain
      and local anaesthetic toxicity. When neurologic complications do occur, the resulting
      morbidity and mortality is considerable. Transversus abdominis plane (TAP) block, is another
      new regional anesthesia technique, has been introduced as an abdominal wall block capable of
      providing effective analgesia, reducing opioid consumption, and lessening opioid-related side
      effects. In addition,TAP block, somewhat as a pre-emptive analgesia approach, is a way of
      pain intervention before noxious stimulation which has been reported to be potent to
      attenuate the stress response. Although the analgesia efficiency of TAP block has been widely
      studied, its effectiveness to suppress stress response has little comparison with classic
      epidural block and general anesthesia. Unlike epidural anaesthesia, TAP block is easy to
      administer and lower incidence for side-effects.The investigators hypothesize that the TAP
      block reduces the stress response of surgery to the similar extent to epidural anaesthesia
      when combined with a standard general anaesthesia for abdominal surgery.
    

Intervention name(s): Transversus abdominis plane block; Epidural anesthesia; control
Intervention type(s): Other; Other; Other
Intervention description(s): Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.; Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.; The Control group receives standard IV-inhaled general anesthesia.
Intervention MeSH terms: Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: transversus abdominal plane block; epidural anesthesia; stress response; anesthetic recovery