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Before the induction of anesthesia, normal saline is used for bilateral transversus abdominis plane block in a volume of 20 mL of each side.

Before the induction of anesthesia, 0.375% ropivacaine is used for bilateral transversus abdominis plane block in a volume of 20 mL of each side.

Before the induction of anesthesia, 0.4% compound lidocaine is used for bilateral transversus abdominis plane block in a volume of 20 mL of each side.

Before the induction of anesthesia, 0.4% compound lidocaine and 0.4mg/kg esketamine are used for bilateral transversus abdominis plane block in a volume of 20 mL of each side.

Before the induction of anesthesia, normal saline is used for bilateral transversus abdominis plane block in a volume of 20 mL of each side

Normal saline

Before the induction of anesthesia, 0.375% ropivacaine is used for bilateral transversus abdominis plane block in a volume of 20 mL of each side

Before the induction of anesthesia, 0.4% compound lidocaine is used for bilateral transversus abdominis plane block in a volume of 20 mL of each side

Compound lidocaine

Before the induction of anesthesia, 0.4mg/kg esketamine is used for bilateral transversus abdominis plane block

Guolin Wang, MD

Guolin Wang

Purpose:

To explore effects of ultrasound-guided transversus abdominis plane block with compound lidocaine and esketamine on postoperative pain after colorectal cancer surgery.

Poor post-surgical pain control is a leading factor that hinders the physical rehabilitation, and causes acute cognitive impairment and chronic pain syndrome. Recently, the multimodal analgesia strategies to minimise opioid related side effects are highly desirable in open surgical procedures. The transversus abdominis plane block is a novel technique involving injection of local anaesthetic between the internal oblique and the transversus abdominis muscles of the abdominal wall. Although ropivacaine is most commonly used for this technique, the analgesic duration remains not dissatisfied. Compared with ropivacaine, compound lidocaine injection has a better and longer analgesic activity since it contains menthol and ethanol with appropriate concentrations. However, whether compound lidocaine injection is efficiency in the transversus abdominis plane block for abdominal surgery lacks investigations. Herein, we will evaluate the efficacy of ultrasound-guided transversus abdominis plane (USG-TAP) block with compound lidocaine injection and esketamine for postoperative analgesia in patients undergoing colorectal cancer surgery.

Effect of Transversus Abdominis Plane Block With Compound Lidocaine and Esketamine on Pain After Surgery

Effect of Ultrasound-guided Transversus Abdominis Plane Block With Compound Lidocaine and Esketamine on Postoperative Pain in Patients Undergoing Colorectal Cancer Surgery: a Randomized Double-blind Controlled Trial

Each patient was administered analgesics using a PCA (Patient-controlled analgesia) pump containing opioid in normal saline after leaving PACU (Postanesthesia care unit). Opioid cumulative consumption is recorded for 48 hours postoperatively.

The pain score at rest or after movement was evaluated by pain 11-point numerical rating scale (NRS): 0 = no pain, 10 = greatest imaginable pain.

First postoperative pain (NRS≥5) is initially controlled by titration of opioid.

The number of patients with side effects including nausea, vomiting, dizziness, headache, shivering, and pruritus is recorded for 48 hours postoperatively.

The Apfel score was recorded for evaluating risk for developing postoperative nausea and vomiting (PONV).

Gastrointestinal motility was evaluated by recording mean time until passage of flatus

Diffusion area of local anesthetics after transversus abdominis plane block was calculated under ultrasound assistance.

The skin around the incision is stimulated in steps of 5 mm at intervals of 1 s starting outside of the hyperalgesic area in the direction of the incision. The distance from the incision to the first point where a 'painful', 'sore' or 'sharper'feeling occurred is measured and noted. This measurement is repeated at predefined radial lines around the incision. To eliminate the variable length of incision, this length is subtracted from the longer diameter leaving four radial distances from the end and from the middle of the incision. The normalized area of hyperalgesia is calculated by summing up the areas of the remaining four triangles measured by and Von Frey filament.

Blood is collected to measure the level of cytokines (such as IL-18, IL-17, IL-23 ) using ELISA kits.

Blood is collected to measure the level of chemokines (such as CXCL1, CCL7, CCL2) using ELISA kits.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Effect of Transversus Abdominis Plane Block With Compound Lidocaine and Esketamine on Pain After Surgery	NCT05122338	Postoperative P...	Normal saline Ropivacaine Compound lidoca... Esketamine	20 Years - 65 Years	Tianjin Medical University General Hospital
Effect of Transversus Abdominis Plane Block With Compound Lidocaine and Esketamine on Pain After Surgery	NCT05122338	Postoperative P...	Normal saline Ropivacaine Compound lidoca... Esketamine	20 Years - 65 Years	Tianjin Medical University General Hospital
Effect of Transversus Abdominis Plane Block With Compound Lidocaine and Esketamine on Pain After Surgery	NCT05122338	Postoperative P...	Normal saline Ropivacaine Compound lidoca... Esketamine	20 Years - 65 Years	Tianjin Medical University General Hospital

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