Research Article
Clinical Study on the Efficacy and Safety of Paracetamol Combined with TAPB Nerve Block in Elderly Patients Undergoing Gastrointest
Zhifu Zhao*
,
Li Liu,
Xianjie Zhang,
Feng Ju,
Wenhu Zhai,
Dan Zhou
Issue:
Volume 14, Issue 3, June 2026
Pages:
39-48
Received:
27 April 2026
Accepted:
7 May 2026
Published:
18 May 2026
DOI:
10.11648/j.js.20261403.11
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Abstract: Objective This study explored the efficacy of paracetamol mannitol injection combined with TAPB for postoperative pain relief in elderly patients after laparoscopic radical gastrectomy, as this combined regimen also reduces postoperative complications including delirium, nausea, vomiting and impaired wound healing, offering a novel strategy for postoperative pain management in such patients. Methods This prospective study included 150 elderly patients (≥65 years) undergoing laparoscopic radical gastrectomy, who were randomly assigned to three groups: sufentanil alone (S), sufentanil plus TAPB (ST), and sufentanil combined with TAPB and paracetamol mannitol (STA). All patients received routine vital sign and BIS monitoring with standardized vascular access establishment before anesthesia. Each group received corresponding preoperative interventions, and multiple perioperative indicators were compared, including opioid consumption, hemodynamic parameters, surgical and anesthetic variables, postoperative pain scores, adverse events, recovery outcomes and patient satisfaction. Results No significant intergroup differences were found in baseline demographics, perioperative indicators, intraoperative vital signs, vasoactive agent use, postoperative adverse reactions, gastrointestinal recovery indicators and bile acid levels among the three groups (all P>0.05). Compared with Group S and ST, the STA group presented decreased intraoperative consumption of sufentanil, remifentanil and propofol, reduced postoperative morphine requirement, prolonged time to the first moderate-severe pain, lower postoperative visual analogue scale (VAS) pain scores, higher early postoperative Confusion Assessment Method (CAM) scores without postoperative delirium, superior patient satisfaction, milder shoulder pain, earlier out-of-bed activity and shorter hospital stay; additionally, the ST group consumed fewer intraoperative anesthetics and exhibited better analgesic effects than the S group, while the slight difference in morphine consumption between the STA and ST groups was not statistically significant. Conclusions Combined application of TAPB and paracetamol mannitol can effectively alleviate early postoperative pain, cut down opioid consumption, relieve pain-induced restrictions on out-of-bed activity and improve satisfaction in elderly patients undergoing laparoscopic radical gastrectomy, which greatly optimizes postoperative pain management; meanwhile, paracetamol mannitol brings no extra risks to gastrointestinal function recovery or gastrointestinal bleeding, ensuring its safe application for postoperative analgesia in this elderly patient population.
Abstract: Objective This study explored the efficacy of paracetamol mannitol injection combined with TAPB for postoperative pain relief in elderly patients after laparoscopic radical gastrectomy, as this combined regimen also reduces postoperative complications including delirium, nausea, vomiting and impaired wound healing, offering a novel strategy for pos...
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Review Article
Nissen Versus Toupet Fundoplication in GERD: Comparable Long-term Outcomes with Distinct Functional Profiles
Issue:
Volume 14, Issue 3, June 2026
Pages:
49-59
Received:
4 March 2026
Accepted:
3 April 2026
Published:
19 May 2026
DOI:
10.11648/j.js.20261403.12
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Abstract: Background: Gastroesophageal reflux disease (GERD) is a prevalent condition with significant impact on quality of life. When medical therapy fails, surgical intervention—most commonly Nissen (NF) or Toupet fundoplication (TF)—is indicated. The optimal technique, however, remains debated. Aim: To compare the efficacy, functional outcomes, and complication profiles of Nissen and Toupet fundoplication in the surgical management of GERD. Methods: A systematic review was conducted in accordance with PRISMA guidelines. PubMed/MEDLINE, Cochrane, SciELO, and LILACS databases were searched for studies published between 2002 and 2025. Randomized controlled trials and cohort studies comparing NF and TF with at least 12 months of follow-up were included. Primary outcomes were postoperative dysphagia and reflux control. Secondary outcomes included proton pump inhibitor (PPI) use, quality of life (QoL), patient satisfaction, and reoperation rates. Results: Nine studies comprising 2,130 patients were included, including six randomized controlled trials. Both techniques provided effective and sustained reflux control. Nissen fundoplication demonstrated higher postoperative lower esophageal sphincter pressure and slightly better objective acid suppression in some studies; however, this did not translate into superior long-term clinical outcomes. Toupet fundoplication was associated with lower rates of early postoperative dysphagia and better preservation of esophageal motility. Long-term outcomes—including PPI use, QoL, and patient satisfaction—were comparable between techniques. Differences in dysphagia diminished over time. Conclusion: Nissen and Toupet fundoplication offer equivalent long-term control of GERD. While NF provides greater sphincter augmentation, TF achieves similar clinical outcomes with fewer early functional side effects. Surgical decision-making should prioritize esophageal motility and patient-specific characteristics rather than maximal acid suppression alone.
Abstract: Background: Gastroesophageal reflux disease (GERD) is a prevalent condition with significant impact on quality of life. When medical therapy fails, surgical intervention—most commonly Nissen (NF) or Toupet fundoplication (TF)—is indicated. The optimal technique, however, remains debated. Aim: To compare the efficacy, functional outcomes, and compli...
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