Comparison of the Stress Responses After TAP Block and Epidural Anesthesia in Patients Undergoing Elective Laparoscopic Cholecystectomy Under General Anesthesia: Randomized Clinical Trial.

Abstract

Objective: Major surgeries and the accompanied acute stress response are associated with poor immune system function and extensive immunologic changes. This study was conducted to compare postsurgery stress responses after transversus abdominis plane (TAP) blocks and epidural anesthesia in patients undergoing laparoscopic cholecystectomy under general anesthesia.

Materials and methods: Sixty patients who were candidates for laparoscopic cholecystectomy were enrolled in this randomized controlled trial. After randomly assigning patients into 2 groups (30 patients in epidural anesthesia and 30 patients in the TAP block group), the degree of pain and stress responses (serum level of blood glucose, C-reactive protein [CRP], interleukin-1, tumor necrosis factor-alpha, cortisol) of patients were measured preoperatively and at 6 and 24 hours after surgery.

Results: Mean blood glucose, serum cortisol, CRP, and white blood cell decreased significantly 6 and 24 hours after the intervention in both groups and differed significantly between the 2 groups ( P -value <0.05). The proportion of patients with a pain score greater than 3 at 6 and 12 hours after surgery was significantly higher in the Epidural group compared with the TAP block group, although this figure was significantly higher in the TAP block group 24 hours after surgery.

Discussion: A significant decrease in the mean blood sugar, serum cortisol, CRP, and white blood cell in both groups at 6 and 24 hours after the surgery was noted. The pain score decreased 24 hours after surgery in the epidural anesthesia group and increased in the TAP block group.