Role of transversus abdominis plane block combined with multimodal analgesia in early recovery after radical colorectal cancer surgery

Table 1 Comparison of general data between two groups, n (%)

Item	Observation group (n = 59)	Control group (n = 58)	Statistic	P value
Gender			χ2 = 0.145	0.703
Male	35 (59.3)	33 (56.9)
Female	24 (40.7)	25 (43.1)
Age (years, mean ± SD)	58.6 ± 10.2	59.3 ± 9.8	t = 0.389	0.698
BMI (kg/m2, mean ± SD)	23.4 ± 2.8	23.7 ± 2.6	t = 0.618	0.538
ASA classification			Z = -0.326	0.744
Grade I	18 (30.5)	16 (27.6)
Grade II	32 (54.2)	34 (58.6)
Grade III	9 (15.3)	8 (13.8)
Tumor location			χ2 = 0.069	0.793
Colon	37 (62.7)	35 (60.3)
Rectum	22 (37.3)	23 (39.7)
TNM staging			Z = -0.158	0.875
Stage I	12 (20.3)	11 (19.0)
Stage II	26 (44.1)	27 (46.6)
Stage III	21 (35.6)	20 (34.4)
Surgical approach			χ2 = 0.892	0.926
Right hemicolectomy	19 (32.2)	17 (29.3)
Left hemicolectomy	11 (18.6)	13 (22.4)
Sigmoid colectomy	7 (11.9)	5 (8.6)
Anterior rectal resection	18 (30.5)	19 (32.8)
Abdominoperineal resection	4 (6.8)	4 (6.9)
Operative time (minute, mean ± SD)	186.4 ± 35.7	189.2 ± 38.1	t = 0.415	0.679
Intraoperative blood loss (mL, mean ± SD)	82.3 ± 28.6	85.7 ± 31.2	t = 0.622	0.535

BMI: Body mass index; ASA: American Society of Anesthesiologist; TNM: Tumor, node, and metastasis.

Table 2 Comparison of Visual Analog Scale scores at different postoperative time points between two groups (points, mean ± SD)

Time point	Resting VAS score			Movement VAS score
	Observation group (n = 59)	Control group (n = 58)	P value	Observation group (n = 59)	Control group (n = 58)	P value
Postop 6 hours	2.1 ± 0.8	3.4 ± 1.1	< 0.001	3.5 ± 1.0	4.9 ± 1.3	< 0.001
Postop 12 hours	1.8 ± 0.7	2.9 ± 0.9	< 0.001	3.1 ± 0.9	4.3 ± 1.1	< 0.001
Postop 24 hours	1.5 ± 0.6	2.4 ± 0.8	< 0.001	2.7 ± 0.8	3.7 ± 1.0	< 0.001
Postop 48 hours	1.2 ± 0.5	1.9 ± 0.7	< 0.001	2.2 ± 0.7	3.1 ± 0.9	< 0.001
Postop 72 hours	1.0 ± 0.4	1.5 ± 0.6	< 0.001	1.8 ± 0.6	2.5 ± 0.8	< 0.001

Bonferroni method was used for multiple comparison correction, with corrected significance level α = 0.01; indicates P < 0.001, remaining statistically significant after correction.

VAS: Visual Analog Scale.

Table 3 Comparison of analgesia-related indicators between two groups

Indicator	Observation group (n = 59)	Control group (n = 58)	Statistic	P value
Effective PCIA pump presses [times, M (Q1, Q3)]	8.0 (6.0, 10.0)	14.0 (11.0, 18.0)	Z = -6.825	< 0.001
Cumulative sufentanil at 72 hours postop (μg, mean ± SD)	68.5 ± 15.3	89.7 ± 18.6	t = 6.842	< 0.001
Analgesia satisfaction score (points, mean ± SD)	4.3 ± 0.6	3.7 ± 0.7	t = 5.025	< 0.001
Rescue analgesia incidence rate, n (%)	6 (10.2)	18 (31.0)	χ2 = 7.783	0.005

PCIA: Patient-controlled intravenous analgesia.

Table 4 Comparison of early recovery indicators between two groups (hour, mean ± SD)

Indicator	Observation group (n = 59)	Control group (n = 58)	t value	P value
Time to first ambulation	18.6 ± 4.3	24.8 ± 5.7	6.731	< 0.001
Time to first flatus	42.3 ± 10.8	56.7 ± 13.4	6.475	< 0.001
Time to first oral Intake	16.2 ± 3.8	21.5 ± 5.2	6.332	< 0.001

Table 5 Comparison of stress response indicators between two groups (mean ± SD)

Indicator	Time point	Observation group (n = 59)	Control group (n = 58)	t value	P value	After correction
IL-6 (pg/mL)	Preop day 1	12.8 ± 3.6	13.1 ± 3.8	0.447	0.656	NS
	Postop day 1	86.5 ± 18.4	112.3 ± 22.6	6.878	< 0.001	P < 0.001
	Postop day 3	45.2 ± 12.7	63.8 ± 15.3	7.256	< 0.001	P < 0.001
CRP (mg/L)	Preop day 1	5.2 ± 1.8	5.4 ± 1.9	0.588	0.558	NS
	Postop day 1	68.4 ± 15.2	89.6 ± 18.9	6.898	< 0.001	P < 0.001
	Postop day 3	38.7 ± 10.5	54.3 ± 13.8	6.95	< 0.001	P < 0.001
Cor (nmol/L)	Preop day 1	285.3 ± 45.6	289.7 ± 48.2	0.517	0.606	NS
	Postop day 1	486.8 ± 68.4	562.5 ± 82.3	5.538	< 0.001	P < 0.001
	Postop day 3	368.2 ± 52.7	428.6 ± 64.5	5.685	< 0.001	P < 0.001

Bonferroni method was used for multiple comparison correction of 3 time points for each indicator, with corrected significance level α = 0.017. NS indicates not statistically significant (P > 0.05). P < 0.001 after correction indicates remaining statistically significant after correction. IL-6: Interleukin-6; CRP: C-reactive protein; Cor: Cortisol.

Table 6 Comparison of postoperative adverse reactions between two groups, n (%)

Adverse reaction	Observation group (n = 59)	Control group (n = 58)	Statistic	P value
Nausea and vomiting			Z = -2.534	0.011
Grade 0	45 (76.3)	32 (55.2)
Grade I	11 (18.6)	17 (29.3)
Grade II	3 (5.1)	7 (12.1)
Grade III	0 (0)	2 (3.4)
Urinary retention	3 (5.1)	6 (10.3)	Fisher’s exact test	0.312
Skin itching	2 (3.4)	4 (6.9)	Fisher’s exact test	0.431
Respiratory depression	0 (0)	0 (0)	-	-
Dizziness and drowsiness	8 (13.6)	18 (31.0)	χ2 = 5.123	0.024

Table 7 Comparison of postoperative recovery quality scores between two groups (points, mean ± SD)

Time point	Observation group (n = 59)	Control group (n = 58)	t value	P value	After correction
Postop 24 hours	108.6 ± 12.4	95.3 ± 14.7	5.436	< 0.001	P < 0.001
Postop 48 hours	122.5 ± 11.8	110.2 ± 13.5	5.389	< 0.001	P < 0.001

Bonferroni method was used for multiple comparison correction of 2 time points, with corrected significance level α = 0.025. P < 0.001 after correction indicates remaining statistically significant after correction.

Table 8 Comparison of postoperative complications between two groups, n (%)

Complication	Observation group (n = 59)	Control group (n = 58)	Statistic	P value
Wound infection	2 (3.4)	3 (5.2)	Fisher’s exact test	0.677
Pulmonary infection	3 (5.1)	5 (8.6)	Fisher’s exact test	0.492
Anastomotic leakage	1 (1.7)	2 (3.4)	Fisher’s exact test	0.617
Intestinal obstruction	2 (3.4)	3 (5.2)	Fisher’s exact test	0.677
Total incidence	8 (13.6)	13 (22.4)	χ2 = 1.541	0.214
Clavien-Dindo classification			Z = -0.985	0.325
Grade I	4 (6.8)	5 (8.6)
Grade II	3 (5.1)	6 (10.3)
Grade IIIa	1 (1.7)	2 (3.4)
Grade IIIb and above	0 (0)	0 (0)