Randomized Controlled Trial
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2025; 17(6): 102907
Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.102907
Effect of dexmedetomidine-ropivacaine transversus abdominis plane block on analgesia and cognitive impairment risk in colorectal cancer surgery
Xing Zhang, Guang-Rong Xiang, Zhi-Xin Wang, Ming-Qing Peng, Min Li
Xing Zhang, Ming-Qing Peng, Department of Anesthesiology, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China
Xing Zhang, Guang-Rong Xiang, Zhi-Xin Wang, Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing 400014, China
Min Li, Intensive Care Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China
Co-corresponding authors: Ming-Qing Peng and Min Li.
Author contributions: Zhang X and Peng MQ conceived this project; Xiang GR collected and analyzed the data; Zhang X, Peng MQ, and Li M wrote the initial draft of the manuscript; Peng MQ and Wang ZX provided expert advice and made revisions to the manuscript; Peng MQ and Li M have made equal contributions as co-corresponding authors and approved the submitted manuscript version.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Yongchuan Hospital of Chongqing Medical University.
Clinical trial registration statement: This study is registered at the Clinical Registry https://www.researchregistry.com (Researchregistry11123).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: No data available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming-Qing Peng, MD, Chief Physician, Department of Anesthesiology, Yongchuan Hospital of Chongqing Medical University, No. 439 Xuanhua Road, Yongchuan District, Chongqing 402160, China. 400159@hospital.cqmu.edu.cn
Received: February 18, 2025
Revised: March 24, 2025
Accepted: April 24, 2025
Published online: June 27, 2025
Processing time: 101 Days and 3 Hours
Abstract
BACKGROUND

The dexmedetomidine (DEX) plus ropivacaine treatment enables a transversus abdominis plane block (TAPB) of the peripheral nerves in patients undergoing radical resection for colorectal cancer (CRC) that can provide clinical data for improving the postoperative analgesic effect, reducing the risk of cognitive impairment, and decreasing the circulating levels of serum inflammatory factors and stress hormones.

AIM

To assess the impact of DEX plus ropivacaine-enabled TAPB on pain, postoperative cognitive dysfunction (POCD), and inflammatory/stress factors.

METHODS

Our patient cohort was randomly divided into control and observation groups (60/group). The observation group used a DEX plus ropivacaine-enabled TAPB, while the control group employed a ropivacaine-enabled TAPB. The pain score [Visual Analogy Scale (VAS), Montreal Cognitive Assessment (MoCA)], serum inflammatory factor level (C-reactive protein, interleukin-6 and tumor necrosis factor-α), serum stress hormone levels (cortisol and adrenaline) and postoperative adverse reactions were compared between the two groups.

RESULTS

The observation group VAS scores were lower than those of the control group (better analgesic effect, P < 0.05). The MoCA and POCD scores decreased post-surgery in the observation group (P < 0.05). In the elderly, the overall VAS and MoCA scores were significantly reduced compared with the young group. The C-reactive protein, interleukin-6, tumor necrosis factor-α, cortisol and adrenaline levels were lower in the observation group compared with the control group post-surgery (P < 0.05). There was no significant difference in adverse reactions between the two groups post-surgery, but the incidence of adverse reactions in the observation group was still lower. DEX continuously inhibited p65-phosphorylation levels in the nuclear factor κB pathway at multiple time points, and its inhibitory effect became more significant over time.

CONCLUSION

DEX plus ropivacaine-enabled TAPB reduces POCD and inflammatory/stress hormone levels, and significantly improves the postoperative analgesic effect of patients undergoing radical resection for colorectal cancer.

Keywords: Radical resection; Colorectal cancer; Dexmedetomidine; Ropivacaine; Transversus abdominis; Plane block

Core Tip: The dexmedetomidine plus ropivacaine combination for transversus abdominis plane block significantly improves postoperative outcomes in patients undergoing radical resection for colorectal cancer. This treatment enhances pain control, reduces postoperative cognitive dysfunction, and lowers the levels of serum inflammatory markers and stress hormones, such as cortisol and adrenaline. The approach provides a promising strategy for better managing postoperative analgesia and minimizing cognitive decline, particularly in elderly patients. Moreover, it demonstrates a favorable safety profile with fewer adverse reactions compared to traditional analgesic methods, making it a valuable addition to colorectal surgery protocols.