Efficacy of an intercostal nerve block administered with general anesthesia in elderly patients undergoing distal gastrectomy.

Objective: The purpose of this study was to evaluate the efficacy and safety of administration of an intercostal nerve block (INB) with general anesthesia to elderly patients undergoing a distal gastrectomy.

Methods: Elderly patients (>65 years) undergoing selective gastrectomy were randomly assigned to three groups (n = 80): general anesthesia (Group A); general + INB anesthesia (Group B); or, general + epidural anesthesia (Group C). General anesthesia was maintained with propofol, remifentanil and cisatracurium. The mean arterial blood pressure (MAP), heart rate (HR) and C-reactive protein (CRP) levels were determined before anesthesia (T0) and at 5 min after intubation (T1), skin incision (T2), exploration of the peritoneal cavity (T3), gastrointestinal anastomosis (T4), end of operation (T5) and 10 min after extubation (T6).

Results: MAP decreased at T1 in all groups (P < 0.05) and at T2, T4 and T5 in Group C (P < 0.05) and was lower in Group C than Group B at T2 and T4 (P < 0.05). There were no differences in MAP between Groups A and B or between Groups B and C. HR increased at T2-T6 in Group A (P < 0.05) and was higher at T2-T6 in Group B and Group C (P < 0.05). CRP levels decreased at T2-T5 in Groups B and C (P < 0.05) and were lower in Groups B and C compared with Group A (P < 0.05). Propofol and remifentanil doses were lower in Groups B and C (P < 0.05 and P < 0.01, respectively) and patients recovered faster than in Group A (P < 0.05).

Conclusions: Administration of INB with general anesthesia enhanced analgesia, led to stable hemodynamics, and reduced anaesthetic consumption and postoperative stress response.