Clinical Study on the Efficacy and Safety of Paracetamol Combined with TAPB Nerve Block in Elderly Patients Undergoing Gastrointest

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.