Background: Surgical stress induces the release of neuroendocrine mediators and cytokines during perioperative period, which may have adverse effects on cancer patients. While the surgical stress responsse can be affected by anesthetic technique. Therefore, we designed this study to assess whether subcostal transversus abdominis plane (TAP) block can affect perioperative neuroendocrine stress response, postoperative analgesia and postoperative recovery in patients undergoing radical gastrectomy under general anesthesia. Methods: Sixty-five patients were recruited. Patients randomly received general anesthesia (control group), or general anesthesia combined with TAP block (40 mL of 0.375% ropivacaine) (TAP group). The primary outcome was neuroendocrine levels including norepinephrine (NE), epinephrine (E), cortisol (Cor), glucose (Glu), interleukin (IL)-6 and IL-10 during 48 h after surgery. Secondary outcomes included pain score, hemodynamic variables and recovery characteristics. Results: Data from 61 of 65 patients were analyzed. The levels of NE, E, Cor, and Glu were blunt by TAP block during perioperative period. The levels of IL-6 and IL-10 were significantly lower in TAP group than in control group. TAP block efficiently relieved postoperative acute pain up to 12 h postoperatively with more stable perioperative hemodynamics compared with control group. Conclusions: Subcostal TAP block blunts perioperative stress response and provides efficient analgesia, with good hemodynamic stability and minimal adverse effects.

Acute non-cardiogenic pulmonary edema (ANPE) is a rare but challenging complication which occurs during the perioperative period, mainly before and after the extubation in the course of the recovery period of general anesthesia. It is characterized by increased fluid in extravascular pulmonary spaces, preventing gas exchange and further resulting in respiratory failure. A 12-year-old boy who had undergone island skin flap in the right upper limb and who developed a unilateral pulmonary edema after the administration of neostigmine during the recovery period of general anesthesia. The neostigmine was administered to reverse neuromuscular block. Acute non-cardiogenic pulmonary edema. The patient was transferred to intensive care unit (ICU) and treated with mechanical ventilation (controlled mode ventilation pattern, CMV) and other supportive treatment. The oxyhemoglobin saturation of the patient returned to the normal level with symptoms and signs of ANPE significantly alleviated. The mechanical ventilation was withdrawn by the fourth day, and no sequela of vital organs was observed. Although neostigmine is widely used for recovery from neuromuscular block and exhibits satisfactory effect in most cases, there is a potential risk of ANPE in some cases, which is rare but potentially fatal and could affect the patient outcomes. Therefore, it is necessary for anesthetists to closely monitor the vital signs of patients after administration of neostigmine in the perioperative period.

Background: This study aimed to assess the effect of subcostal transversus abdominis plane (TAP) block on perioperative neuroendocrine stress response, postoperative analgesia, and recovery profiles in patients undergoing radical gastrectomy with general anesthesia. Methods: Sixty-five patients were recruited. Patients randomly received general anesthesia (control group), or general anesthesia combined with TAP block (40 mL of 0.375% ropivacaine) (TAP group). The primary endpoint was neuroendocrine levels including norepinephrine (NE), epinephrine (E), cortisol (Cor), glucose (Glu), interleukin (IL)-6 and IL-10 during 48 h after surgery. Secondary endpoints included pain score, hemodynamic variables and recovery characteristics. Results: Data from 61 of 65 patients were analyzed. The levels of NE, E, Cor, and Glu were blunt by TAP block during perioperative period. The levels of IL-6 and IL-10 were significantly lower in TAP group than in control group. TAP block efficiently relieved postoperative acute pain up to 12 h postoperatively with more stable perioperative hemodynamics compared with control group. Conclusions: Subcostal TAP block blunts perioperative stress response and provides efficient analgesia, with good hemodynamic stability and minimal adverse effects. Trial registration The trial was registered prior to patient enrollment at clinicaltrials.gov (NCT03035916, principal investigator: Guoqing Zhao, Ruizhu Liu, Kai Li, date of registration: 01/27/2017).

Background: Surgical stress induces the release of neuroendocrine mediators and cytokines during perioperative period, which may have adverse effects on cancer patients. While the surgical stress response can be affected by anesthetic technique. Therefore, we designed this study to assess whether subcostal transversus abdominis plane (TAP) block can affect perioperative neuroendocrine stress response, postoperative analgesia and postoperative recovery in patients undergoing radical gastrectomy under general anesthesia. Methods: Sixty-five patients were recruited. Patients randomly received general anesthesia (control group), or general anesthesia combined with TAP block (40 mL of 0.375% ropivacaine) (TAP group). The primary outcome was neuroendocrine levels including norepinephrine (NE), epinephrine (E), cortisol (Cor), glucose (Glu), interleukin (IL)-6 and IL-10 during 48 h after surgery. Secondary outcomes included pain score, hemodynamic variables and recovery characteristics. Results: Data from 61 of 65 patients were analyzed. The levels of NE, E, Cor, and Glu were blunt by TAP block during perioperative period. The levels of IL-6 and IL-10 were significantly lower in TAP group than in control group. TAP block efficiently relieved postoperative acute pain up to 12 h postoperatively with more stable perioperative hemodynamics compared with control group. Conclusions: Subcostal TAP block blunts perioperative stress response and provides efficient analgesia, with good hemodynamic stability and minimal adverse effects.