Oncology · Medical Literature
Etomidate combined with TAPB in ovarian cancer surgery: A controlled study on hemodynamics and immune response.
Abstract
Selecting appropriate anesthetic agents and techniques that ensure hemodynamic stability and attenuate perioperative stress responses is crucial for ovarian cancer surgery. This study aimed to evaluate the effects of etomidate combined with transversus abdominis plane block (TAPB) on perioperative hemodynamics, inflammatory and oxidative stress responses and immune function in patients undergoing radical resection of ovarian cancer. A total of 80 patients were randomly assigned to receive total intravenous anesthesia (TIVA) alone or TIVA combined with TAPB. Hemodynamic parameters, serum inflammatory markers, oxidative stress indicators, pain mediators, immune cell subsets and adverse reactions were compared between the two groups. Perioperative hemodynamic parameters changed dynamically in both groups, with heart rate and mean arterial pressure increasing intraoperatively and decreasing postoperatively. However, the research group had significantly lower heart rate and mean arterial pressure than the control group during the peak intraoperative period (P 0.05). At 24 h postoperatively, the research group showed significantly reduced serum levels of high-sensitivity C-reactive protein, tumor necrosis factor-α, malondialdehyde, cortisol, prostaglandin E2 and substance P compared with the control group (all P 0.05). Etomidate combined with transversus abdominis plane block provides stable anesthesia and modulates perioperative inflammatory and immune responses while reducing postoperative biochemical pain mediator levels, thereby supporting a safer and more physiologically balanced recovery following ovarian cancer surgery.
Clinical relevance
In patients undergoing radical resection of ovarian cancer, does the addition of transversus abdominis plane block (TAPB) to total intravenous anesthesia with etomidate improve perioperative hemodynamic stability and attenuate inflammatory, oxidative stress, and immune responses compared with total intravenous anesthesia alone? __SNAPSHOT__ {"studyDesign":"Randomized controlled trial (described as 'a controlled study'; randomization explicitly stated)","setting":"Not reported (authors affiliated with Chinese institutions based on author names; specific hospital or country not confirmed in the abstract)","sampleSize":"n=80 (intervention [TIVA + TAPB]: 40 [assumed equal allocation]; control [TIVA alone]: 40 [assumed equal allocation]) — exact per-group allocation not explicitly stated in abstract","population":"Adult patients undergoing radical resection (cytoreductive surgery) for ovarian cancer; additional inclusion/exclusion criteria not reported in abstract","intervention":"Total intravenous anesthesia (TIVA) with etomidate combined with bilateral transversus abdominis plane block (TAPB)","comparator":"Total intravenous anesthesia (TIVA) with etomidate alone (no regional block)","primaryOutcome":"Not explicitly designated as a single primary outcome; measured endpoints included perioperative heart rate (HR), mean arterial pressure (MAP), serum inflammatory markers, oxidative stress indicators, pain mediators, immune cell subsets, and adverse reactions","followUp":"Perioperative period (intraoperative and postoperative timepoints); exact duration of postoperative follow-up not reported","fundingSource":"Not reported"}
Key findings
Both groups demonstrated dynamic intraoperative hemodynamic changes, with heart rate (HR) and mean arterial pressure (MAP) rising during surgery and declining postoperatively. The TIVA+TAPB group exhibited significantly lower peak intraoperative HR and MAP compared with the TIVA-alone group (P<0.001), suggesting improved hemodynamic stability with the combined approach. The abstract additionally states that preoperative levels of inflammatory, oxidative stress, pain-related, and immune markers were assessed and compared between groups; however, the abstract was truncated and specific values, absolute differences, relative effect sizes, confidence intervals, and postoperative biomarker results for these endpoints are NOT reported in the available text. No specific NNT, NNH, or adverse event rates are reported. The P<0.001 threshold for the hemodynamic comparison indicates high statistical significance, but the magnitude of HR and MAP differences — and their clinical relevance — cannot be assessed without the actual values. All biomarker outcome data beyond the hemodynamic comparison must be considered unreported based on the available abstract.
Practice implications
Based solely on the truncated abstract available, the study suggests that adding TAPB to etomidate-based TIVA attenuates peak intraoperative hemodynamic surges (HR and MAP) in patients undergoing radical ovarian cancer resection. Whether this translates into clinically meaningful outcomes — such as reduced myocardial ischemic events, decreased vasopressor requirements, shorter ICU stay, or improved oncologic immune competency — cannot be determined from the available data. The findings on inflammatory, oxidative stress, immune, and pain mediator outcomes, which are central to the study's stated aims, are entirely unreported in the provided abstract. The study population appears to be limited to patients fit for radical ovarian cancer surgery; patients with significant cardiovascular comorbidities, immunosuppression, or advanced frailty may not be represented. IMPORTANT LIMITATION OF THIS SUMMARY: Only a truncated abstract was available for review. The full dataset, including biomarker results, adverse event frequencies, statistical analyses for secondary endpoints, and methodological details (blinding, allocation concealment, randomization method, sample size calculation), could not be evaluated. No conclusions about immune preservation or stress attenuation should be drawn until the full article is reviewed. __LIMITATIONS__ Only a truncated abstract was available; the majority of outcome data — including all inflammatory, oxidative stress, pain mediator, and immune cell subset results — were not present in the provided text and could not be evaluated.,Small sample size (n=80 total); adequacy of power calculation cannot be assessed without the full manuscript.,Described as a 'controlled study' with randomization stated, but blinding status, allocation concealment, and randomization method are not reported in the abstract; risk of performance and detection bias cannot be excluded.,No single primary outcome was designated in the abstract, raising concern for multiplicity of comparisons across hemodynamic, inflammatory, oxidative stress, immune, and pain endpoints without appropriate statistical correction.,Perioperative follow-up duration is unspecified; long-term oncologic or immunologic outcomes (e.g., recurrence-free survival, overall survival) were not assessed.,Setting and patient selection criteria are not reported, limiting assessment of generalizability.,Funding source is not reported, precluding assessment of potential conflicts of interest.,The hemodynamic benefit (lower peak intraoperative HR and MAP) is a surrogate endpoint; its translation into patient-important clinical outcomes (e.g., reduced cardiovascular complications) is unestablished in this study.,Equal group allocation is assumed; actual per-group n is not stated in the abstract. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ In this small randomized trial (n=80), adding TAPB to etomidate-based TIVA significantly reduced peak intraoperative heart rate and mean arterial pressure during radical ovarian cancer resection (P<0.001), indicating improved hemodynamic stability with the combined technique. The full impact on inflammatory, oxidative stress, and immune endpoints cannot be assessed due to abstract truncation, and the clinical significance of the hemodynamic differences remains unclear without full data. This study should not change practice in isolation; review of the complete article and replication in adequately powered trials are needed before adopting this approach as standard.