Transversus abdominis plane block reduces remifentanil and propofol consumption, evaluated by closed-loop titration guided by bispectral index

摘要

The present prospective, randomized, double-blind study aimed to determine the impact of transversus abdominis plane (TAP) block on propofol and remifentanil consumption, when administered by closed-loop titration guided by processed electroencephalography, i.e., bispectral index (BIS) values. Following institutional review board approval, 60 patients were scheduled for laparoscopic colectomy under general anesthesia. Patients were randomly assigned to receive bilateral TAP block with 20 ml 0.375% ropivacaine (TAP group) or 20 ml 0.9% saline [control (CON) group]. General anesthesia was maintained with propofol and remifentanil administration using closed-loop titration guided by BIS values. The primary outcome was perioperative propofol and remifentanil consumption. The secondary outcomes were hypertensive or hypotensive events requiring treatment, recovery time in PACU and time to first rescue analgesia following surgery. A total of 58 patients participated in the present study. At similar depths of anesthesia, as measured by BIS during the maintenance phase (45-55), patients who received TAP blocks required less propofol (4.2 +/- 1.3 vs. 5.5 +/- 1.6 mg/kg/h; P0.001) and remifentanil (0.16 +/- 0.05 vs. 0.21 +/- 0.05 mu g/kg/min; P0.001). Time to extubation was significantly shorter in the TAP group (9.8 +/- 3.2 min) than in the CON group (14.2 +/- 4.9 min) (P0.05). The requirement to treat hemodynamic change was also significantly lower (P0.05). Pain score at 2 h after surgery was also significantly reduced in the TAP group compared with the CON group (P0.05), whereas the time to first rescue analgesia was delayed in patients who received TAP block (P0.05). Postoperative nausea and vomiting occurred at comparable rates in each group (P0.05). In conclusion, TAP block combined with general anesthesia reduced propofol and remifentanil consumption, shortened time to tracheal extubation and promoted hemodynamic stability in laparoscopic colectomy.