Published online Sep 27, 2026. doi: 10.4240/wjgs.120404
Revised: May 10, 2026
Accepted: June 16, 2026
Published online: September 27, 2026
Processing time: 173 Days and 22.3 Hours
Older patients undergoing laparoscopic radical gastrectomy (LRG) for gastric cancer (GC) often experience intense postoperative pain and stress responses, compromising recovery and homeostasis.
To analyze the analgesic efficacy of thoracic paravertebral block (TPVB) in older patients undergoing LRG for GC and its impact on homeostasis.
In this study, we used the medical records of 227 older patients with GC who underwent LRG at our hospital from January 2018 to January 2025. Patients received either TPVB plus general anesthesia (combination group, n = 120) or general anesthesia alone (control group, n = 107). Outcomes included operative time, extubation time, visual analog scale (VAS) scores, incidence of adverse reactions, white blood cell count, neutrophil percentage, interleukin-6 levels, arterial partial pressure of O2, partial pressure of CO2, blood lactate, and liver and kidney function indices. Multiple linear regression analysis was used to explore the factors influencing postoperative pain.
No significant inter-group differences were found in the operative or extubation times (P > 0.05). At 6, 24, and 48 hours postoperatively, the combination group had significantly lower VAS scores than the control group (all P < 0.05). At 72 hours postoperatively, the combination group showed significantly lower white blood cell count, neutrophil percentage, and interleukin-6 levels than the control group (all P < 0.05). At 12 hours postoperatively, the combination group showed significantly lower levels of partial pressure of CO2 and lactate than the control group (both P < 0.001), whereas no significant inter-group difference was found in partial pressure of O2 (P > 0.05). No significant differences were observed in the alanine aminotransferase, aspartate aminotransferase, serum creatinine, or blood urea nitrogen levels between both groups preoperatively or at 24 and 72 hours postoperatively. The combination group presented a significantly lower incidence of postoperative nausea and vomiting, and overall complication rate than the control group (P < 0.05). Multiple linear regression identified the anesthesia method (β = -1.567, 95% confidence interval: -1.639 to -1.495, P < 0.001) as the only independent influencing factor for postoperative pain scores.
TPVB plus general anesthesia provided superior postoperative analgesia, effectively mitigated postoperative inflammatory responses, improved pulmonary ventilation and tissue perfusion, maintained homeostasis, and reduced postoperative nausea and vomiting incidences.
Core Tip: In elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer, the combination of thoracic paravertebral block and general anesthesia provides superior postoperative analgesia, as evidenced by significantly lower visual analog scale scores at 6, 24, and 48 hours. This approach also effectively mitigates the inflammatory response (lower white blood cell, neutrophil percentage, and interleukin-6), improves physiological homeostasis (lower partial pressure of CO2 and blood lactate), and reduces the incidence of postoperative nausea and vomiting and overall complications. Multiple linear regression identifies the anesthesia method as the sole independent factor for postoperative pain, while the combination shows no significant additional impact on liver and kidney function.