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

Abstract

Major surgeries and the accompanied acute stress response are associated with poor immune system function and extensive immunological changes. This study was done to compare post-surgery stress responses following TAP blocks and epidural anesthesia in patients undergoing laparoscopic cholecystectomy under general anesthesia. Sixty patients who were candidates for laparoscopic cholecystectomy were enrolled in this RCT. After randomly assigning patients into two 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, CRP, IL-1, TNF-α, cortisol) of patients were measured preoperatively and at 6 and 24 hours after surgery. Mean blood glucose, serum cortisol, CRP, and WBC decreased significantly 6 and 24 hours after the intervention in both groups and differed significantly between the two 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. A significant decrease in the mean blood sugar, serum cortisol, CRP, and WBC 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.