**6. Better intraoperative hemodynamic control by regional anesthesia**

Regional anesthesia combined with general anesthesia provides not only better postopera‐ tive analgesia, but may also result in better intraoperative hemodynamic control than general anesthesia alone [22]. We demonstrated this advantage of regional anesthesia in an investiga‐ tion of high‐risk patients with severe cardiovascular disease classified as American Society of Anesthesiologists (ASA) physical status 3.

Patients undergoing elective open abdominal surgery were randomized into those receiving general anesthesia and a bilateral transversus abdominis plane block (TAPB) (Group T, *n* = 33), and those receiving general anesthesia alone (Group G, *n* = 35). The bilateral TAPB was per‐ formed after anesthesia induction using 40 ml of 0.3% ropivacaine, as shown in **Figure 11**. We compared the groups for intraoperative hemodynamic stability, anesthesia emergence time, amounts of anesthetics and opioids given, and frequency of emergency treatment with a car‐ diovascular agent. A hemodynamically stable period was defined as the time when systolic blood pressure and heart rate were 70–110% of their preanesthesia value. The ratio of hemody‐ namically stable time to total operative time was used as an index of hemodynamic stability.

Hemodynamically stable time was greater in Group T than Group G (**Figure 12**), while sevo‐ flurane concentration, amount of fentanyl given, and frequency of vasopressor use were lower, and anesthesia emergence time was shorter in the Group T patients (**Figure 13**). These find‐ ings indicate that the combination of TAPB with general anesthesia promotes intraoperative hemodynamic stability and early emergence from general anesthesia, while it also provides good postoperative analgesia. Furthermore, the advantageous effects obtained with TAPB may also be seen with use of other regional anesthetic protocols.

**Figure 11.** Ultrasound image of abdominal wall during transversus abdominis plane block (TAPB).

**Figure 12.** Box‐plot for comparison of intraoperative hemodynamic stability between Group G (general anesthesia alone, *n* = 35) and Group T (general anesthesia plus TAPB, *n* = 33). The period during the operation when both systolic blood pressure and heart rate were within 70–110% of their pre‐anesthesia value was defined as the hemodynamic stable time. The ratio of hemodynamic stable time to total operative time was used as an indicator of hemodynamic stability. The stability ratio was significantly higher in Group T (91%, range 50–100%) than in Group G (79, 40–91%), indicating greater hemodynamic stability in Group T. Values are presented as the median and minimum‐maximum range.

Regional Anesthesia: Advantages of Combined Use with General Anesthesia and Useful Tips for Improving... http://dx.doi.org/10.5772/66573 37

**Figure 13.** Box‐plot for comparison of anesthesia emergence time between Group G (general anesthesia alone, *n* = 35) and Group T (general anesthesia plus TAPB, *n* = 33). Anesthesia emergence time was defined as the time from completion of surgery to extubation. That time was significantly shorter in Group T (14 min, range 4–30 min) than in Group G (18 min, 9–52 min). Values are presented as the median and minimum‐maximum range.

It is important for anesthesiologists to offer effective anesthesia management for high‐risk patients with severe cardiovascular disease [23], as they frequently require special treatment with a variety of expensive drugs and increased medical staffing. This combined regional and general anesthesia technique is si mple and easy to perform, and its advantages include relief of the burden to the anesthesiologist and reduced medical costs for such high‐risk cases, as well as improved patient safety.
