A retrospective study was conducted on the clinical data of 85 patients who underwent laparoscopic radical gastrectomy in our hospital from December 2020 to January 2023. Inclusion criteria: Patients undergoing elective laparoscopic radical gastrectomy, patients aged 18-65 years old, patients with grade I to II according to the American Society of Anesthesiologists (ASA), patients with a body mass index (BMI) of 18-24 kg/m², patients undergoing primary surgery, patients who received TAPB or epidural anesthesia, and patients with complete clinical data. Exclusion criteria: A history of analgesic drug abuse, history of abnormal blood coagulation and chronic pain, infection at the puncture site, peripheral neuropathy, and incomplete clinical data. Eighty-five patients were divided into the TAPB group (n = 45) and epidural anesthesia group (n = 40) according to the different anesthesia and analgesia programs they received.

All patients were forbidden to drink and eat for 8 h before surgery, and no drugs were used before the operation. Noninvasive blood pressure, electrocardiogram, oxygen saturation, and double-frequency index (BIS) were monitored after entering the operation room. Peripheral venous access was opened, and radial artery puncture and right internal jugular vein puncture and catheterization were conducted under local anesthesia.

Anesthesia methods for patients in the epidural anesthesia group were as follows: Before general anesthesia induction, the anesthesiologist conducted an epidural puncture and catheterization between T8 and T9 of the patients and adopted the posterior median approach. The oblique angle of the puncture needle was placed longitudinally parallel to the dural fibers, and the needle was slowly advanced. Advancement of the puncture needle was stopped when there was a characteristic resistance change when passing through the ligamentum flavum and dura mater. After cerebrospinal fluid was seen to flow out smoothly, excluding the possibility that the catheter entered the spinal canal and simultaneously verifying the location of the anesthesia plane and epidural catheter, 5 mL of 2% lidocaine was injected; then 4-6 mL of 1% ropivacaine was injected. Anesthesia induction was performed when the patient’s vital signs were stable. The anesthesia induction method was as follows: 0.3-0.4 μg/kg sufentanil, 2 mg/kg propofol, 0.6 mg/kg rocuronium, and 0.5 μg/kg dextrometomidine were used for anesthesia induction, and tracheal intubation was performed after successful induction. For anesthesia maintenance, 4-10 mg/kg/h propofol was used for target-controlled infusion, and the BIS was maintained between 40 and 60. During the surgery, 1% ropivacaine (4-6 mL/h) was administered through an epidural catheter according to the patient’s condition, and 0.1 mg/kg/h cisatracurium was intermittently administered to maintain the neuromuscular block. After pneumoperitoneum was stopped, the use of muscle relaxants was stopped, and the tracheal intubation was removed after reaching the indication for extubation. A patient-controlled intravenous analgesia (PCIA) pump was used after surgery. The drug formula for the injection was 100 μg sufentanil, 4.48 mg tropisetron, and sodium chloride diluted to 100 mL. The parameters were set to 2 mL/h, a single compression dose of 2 mL, and a locking time of 20 min.

The following anesthesia method for patients in the TAPB group was applied. Before general anesthesia induction, the anesthesiologist placed the ultrasonic probe vertically on the anterior axillary line between the patient’s iliac crest and costal margin, and identified the structures of the external oblique, internal oblique, transversal, and peritoneum of the abdomen. Using in-plane technology, a 20G puncture needle was placed in the middle of the transversus abdominis muscle and the internal oblique muscle of the abdomen. After no blood or air bubbles were extracted, 1 mL of sodium chloride was injected using water separation technology to prove that the needle tip was located at the transversus abdominal plane. Then 0.375% ropivacaine and 0.75 μg/kg dexmedetomidine were injected at a uniform rate, using 20 mL on each side. Anesthesia induction was performed after the block was completed. The methods of anesthesia induction and maintenance were the same as those of the epidural anesthesia group.

(1) The general data of the two groups were compared; (2) The visual analog scale (VAS) was used to evaluate the degree of pain felt 6 h, 12 h, 24 h, and 48 h after surgery, with the score ranging from 0 to 10 points. The higher the score, the more severe the pain; (3) The occurrence of POCD 24 h and 72 h after surgery was recorded and compared between the two groups. The Mini-mental State Examination (MMSE) was used to evaluate the cognitive status of the two groups before and after surgery. A score of < 27 points indicated cognitive impairment, and the higher the score, the better the cognitive function; (4) Intestinal barrier function indexes, including diamine oxidase (DAO) and plasma D-lactate (D-LA), for the two groups were compared before and 24 h after surgery; (5) The agitation score and the incidence of agitation of the two groups during the recovery period were recorded and compared. An agitation score of 1 point indicated an inability to wake up, 2 points indicated excessive sedation, 3 points indicated sedation, 4 points indicated sedation and cooperation, 5 points indicated agitation with stimulation, 6 points indicated agitation without stimulation, 7 points indicated severe agitation, and 5 to 7 points indicated agitation during the awakening period; and (6) Postoperative complications were compared between the two groups.

The data obtained were analyzed and processed by SPSS23.0 software. Measurement data conforming to a normal distribution were expressed as the mean ± SD and were compared by t test. Count data were expressed as cases or percentages, and the chi-square test was used for comparison. P < 0.05 was considered to be statistically significant.

There were no statistically significant differences in sex, age, BMI, ASA grade, operation time, or intraoperative bleeding between the two groups (P > 0.05), as shown in Table 1.

Compared with the epidural anesthesia group, TAPB group patients’ VAS scores were significantly lower 6 h, 12 h, 24 h, and 48 h after surgery (P < 0.05), as shown in Table 2.

There was no statistically significant difference in MMSE scores between the two groups before surgery (P > 0.05). The incidence of POCD in the TAPB group was significantly lower than that in the epidural anesthesia group, and the MMSE score was significantly higher in the TAPB group than the epidural anesthesia group 24 h after surgery (P < 0.05), as shown in Table 3.

There were no statistically significant differences in the preoperative DAO or D-LA levels of the two groups (P > 0.05). The DAO and D-LA levels 24 h after surgery in the TAPB group were significantly lower than those in the epidural anesthesia group (P < 0.05), as shown in Table 4.

The agitation score of the TAPB group was significantly lower than that of the epidural anesthesia group, and the incidence of agitation in the TAPB group was significantly lower than that of the epidural anesthesia group during the recovery period (P < 0.05), as shown in Table 5.

The total incidence of postoperative complications in the TAPB group was 4.44%, significantly lower than the 20.00% recorded in the epidural anesthesia group (P < 0.05), as shown in Table 6.

Postoperative complications are important factors affecting the survival time and quality of life of patients undergoing radical gastrectomy. Choosing an ideal anesthesia and analgesia program is of great significance for ensuring good surgical effect and reducing the incidence of postoperative complications. Although patient-controlled intravenous analgesia (PCIA) can control the outbreak of pain in time, opioids can easily cause adverse reactions such as nausea, vomiting, and respiratory depression. Epidural anesthesia combined with general anesthesia is commonly used in abdominal surgery, and ultrasound-guided transversus abdominal plane block (TAPB) is also effective in reducing postoperative pain and reducing the amount of analgesic drugs required. At present, there are few reports on the application of these two schemes in radical gastrectomy.

PCIA has been the most frequently used analgesic regimen in laparoscopic surgery in the past. Although it can control the outbreak of pain in time through the impact dose, the opioids used can easily cause adverse reactions, such as nausea, vomiting, and respiratory depression, which are not conducive to the postoperative rehabilitation of patients. It is thus necessary to optimize the anesthesia and analgesia program. By comparing the effects of epidural anesthesia and TAPB on the incidence of postoperative cognitive dysfunction (POCD), intestinal barrier function, and postoperative recovery quality in patients with laparoscopic gastric cancer, we can gather data that should be helpful when choosing the most suitable anesthesia and analgesia scheme for clinical practice.

The main goal was to select a more appropriate surgical anesthesia/analgesia program for patients with gastric cancer. Multimodal analgesia can prevent the introduction of pain stimulation from many sources and thereby block the transmission of pain signals and improve postoperative rehabilitation. By comparing the effects of epidural anesthesia and TAPB on postoperative recovery quality and complications in patients with laparoscopic gastric cancer, we may find ways to reduce the need to apply opioids during perioperative period and accelerate postoperative rehabilitation.

This was a retrospective study in which differences in postoperative pain, cognitive function, intestinal barrier function index, and incidences of agitation were observed between an epidural anesthesia group and an ultrasound-guided bilateral transversus abdominis plane block group. Cognitive dysfunction is one of the most common complications in patients undergoing laparoscopic gastric cancer surgery, and intestinal barrier function is an important indicator affecting postoperative intestinal peristalsis and recovery speed. By observing these indicators, we can obtain good reference data for future research.

Compared with patients in the epidural anesthesia group, patients in the ultrasound-guided TAPB group had less postoperative pain; significantly lower incidences of cognitive dysfunction, emergence agitation, and postoperative complications; and greater improvements in intestinal barrier function. The differences in the above indicators were statistically significant. However, the effects of the two anesthesia methods on the intraoperative vital signs of patients need to be further explored.

In contrast to previous studies, this study used retrospective analysis to explore and compare the effects of epidural anesthesia and TAPB on cognitive dysfunction, intestinal barrier function, and postoperative recovery quality in patients with laparoscopic gastric cancer. It was concluded that, compared with epidural anesthesia combined with general anesthesia, TAPB combined with general anesthesia had a good analgesic effect in laparoscopic gastric cancer surgery patients. TAPB combined with general anesthesia helped to reduce the incidence of postoperative cognitive dysfunction, and the emergence agitation and concurrent tension, and had a good effect on improving the quality of postoperative recovery.

Because this study was a retrospective analysis, the effects of the two anesthesia/analgesia regimens on the vital signs of a large sample of patients with gastric cancer needs to be analyzed in a prospective study.