<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03035916</url>
  </required_header>
  <id_info>
    <org_study_id>3D5l4L463430</org_study_id>
    <secondary_id>3R210Z893430</secondary_id>
    <nct_id>NCT03035916</nct_id>
  </id_info>
  <brief_title>Transversus Abdominis Plane Block on Stress Response</brief_title>
  <official_title>Effect of Transversus Abdominis Plane Block Combined With General Anesthesia on Perioperative Stress Response in Patients Undergoing Radical Gastrectomy: A Double-blind Randomized Controlled Study.</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Jilin University</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Jilin University</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      This study evaluates the effect of transversus abdominis plane(TAP) block combined with&#xD;
      general anesthesia on perioperative stress response in patients undergoing radical&#xD;
      gastrectomy. One third of participants will receive TAP block combined with general&#xD;
      anesthesia, another one third of participants will receive epidural anesthesia combined with&#xD;
      general anesthesia, while the rest will receive only general anesthesia.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Clinically, combining epidural with general anaesthesia may confer many advantages to&#xD;
      patients undergoing major thoracic, abdominal or orthopaedic surgery. Epidural anaesthesia&#xD;
      can attenuate sympathetic hyperactivity and the stress response, maintain bowel peristalsis,&#xD;
      spare the use of opioids, and facilitate postoperative feeding and physiotherapy. However,&#xD;
      establishing epidural anesthesia is not without risks and contraindications, including&#xD;
      refusal by the patient, technical failure, unintentional dural puncture, waist and back pain&#xD;
      and local anaesthetic toxicity. When neurologic complications do occur, the resulting&#xD;
      morbidity and mortality is considerable. Transversus abdominis plane (TAP) block, is another&#xD;
      new regional anesthesia technique, has been introduced as an abdominal wall block capable of&#xD;
      providing effective analgesia, reducing opioid consumption, and lessening opioid-related side&#xD;
      effects. In addition,TAP block, somewhat as a pre-emptive analgesia approach, is a way of&#xD;
      pain intervention before noxious stimulation which has been reported to be potent to&#xD;
      attenuate the stress response. Although the analgesia efficiency of TAP block has been widely&#xD;
      studied, its effectiveness to suppress stress response has little comparison with classic&#xD;
      epidural block and general anesthesia. Unlike epidural anaesthesia, TAP block is easy to&#xD;
      administer and lower incidence for side-effects.The investigators hypothesize that the TAP&#xD;
      block reduces the stress response of surgery to the similar extent to epidural anaesthesia&#xD;
      when combined with a standard general anaesthesia for abdominal surgery.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">January 20, 2017</start_date>
  <completion_date type="Actual">July 15, 2017</completion_date>
  <primary_completion_date type="Actual">May 31, 2017</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>Double (Investigator, Outcomes Assessor)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Physiological Parameters: Plasma Concentration of Norepinephrine (NE)</measure>
    <time_frame>up to 48h after surgery</time_frame>
    <description>Venous blood samples will be collected at certain time points. The blood samples are collected in a pre-chilled tubes in ice and are centrifuged within 90min, and then separated plasma are stored at -80°C until analysis. The NE levels are measured by ELISA kits.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Physiological Parameters: Plasma Concentration of Epinephrine (E)</measure>
    <time_frame>up to 48h after surgery</time_frame>
    <description>Venous blood samples will be collected at certain time points. The blood samples are collected in a pre-chilled tubes in ice and are centrifuged within 90min, and then separated plasma are stored at -80°C until analysis. The E levels are measured by ELISA kits.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Physiological Parameters: Plasma Concentration of Cortisol (Cor)</measure>
    <time_frame>up to 48h after surgery</time_frame>
    <description>Venous blood samples will be collected at certain time points. The blood samples are collected in a pre-chilled tubes in ice and are centrifuged within 90min, and then separated plasma are stored at -80°C until analysis. The Cor levels are measured by ELISA kits.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Physiological Parameters: Plasma Concentration of Glucose (Glu)</measure>
    <time_frame>up to 48h after surgery</time_frame>
    <description>When venous blood are collected, glucose levels are measured immediately by Glucometer.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Hemodynamic Parameters: Heart Rate.</measure>
    <time_frame>up to 48h after surgery</time_frame>
    <description>Continuous monitoring of heart rate to 48 hours after surgery.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Hemodynamic Parameters: Mean Arterial Pressure(MAP)</measure>
    <time_frame>up to 48h after surgery</time_frame>
    <description>Continuous monitoring of mean arterial pressure(MAP) to 48 hours after surgery. mean arterial pressure(MAP)＝ (systolic blood pressure＋2×diastolic blood pressure)/3</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Anesthetics Consumption: Sufentanil Consumption</measure>
    <time_frame>during operation</time_frame>
    <description>Intraoperative superaddition of sufentanil was measured.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Questionnaire: Pain Scores at Rest</measure>
    <time_frame>1hr, 6hr, 12hr, 24hr, and 48hr after surgery</time_frame>
    <description>Pain scores of the participants will be measured by the Visual Analogue Scale. Measurement of VAS: Draw a 10cm horizontal line on the paper. The VAS were anchored at 0cm(no pain) and 10cm(worst possible pain), the middle part shows varying degrees of pain, the greater of the number, the worse of the pain.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Questionnaire: Pain Scores on Movement</measure>
    <time_frame>1hr, 6hr, 12hr, 24hr, and 48hr after surgery</time_frame>
    <description>Pain scores of the participants will be measured by the Visual Analogue Scale. Measurement of VAS: Draw a 10cm horizontal line on the paper. The VAS were anchored at 0cm(no pain) and 10cm(worst possible pain), the middle part shows varying degrees of pain, the greater of the number, the worse of the pain.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Anesthesia Recovery: the Time of First Flatus</measure>
    <time_frame>Through study completion, an average of 2 weeks</time_frame>
    <description>The time of first flatus was measured after surgery.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Anesthesia Recovery: Number of Participants With Prolonged Hospitalization</measure>
    <time_frame>Through study completion, an average of 2 weeks</time_frame>
    <description>The percentage of long hospitalization were measured. More than 7 days after surgery is defined as prolonged hospitalization.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Side Effects: Number of Participants With Sedation</measure>
    <time_frame>up to 48h after surgery</time_frame>
    <description>The state of sedation was evaluated after surgery during first postoperative 48 hours.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Side Effects: Number of Participants With Nausea</measure>
    <time_frame>up to 48h after surgery</time_frame>
    <description>The state of nausea was evaluated after surgery during first postoperative 48 hours.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Side Effects: Number of Participants With Vomiting</measure>
    <time_frame>up to 48h after surgery</time_frame>
    <description>The state of vomiting was evaluated after surgery during first postoperative 48 hours.</description>
  </secondary_outcome>
  <number_of_arms>3</number_of_arms>
  <enrollment type="Actual">91</enrollment>
  <condition>Gastrostomy</condition>
  <arm_group>
    <arm_group_label>Transversus abdominis plane block</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Epidural anesthesia</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Control</arm_group_label>
    <arm_group_type>Placebo Comparator</arm_group_type>
    <description>The Control group receives standard IV-inhaled general anesthesia.</description>
  </arm_group>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Transversus abdominis plane block</intervention_name>
    <description>Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
    <arm_group_label>Transversus abdominis plane block</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Epidural anesthesia</intervention_name>
    <description>Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
    <arm_group_label>Epidural anesthesia</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>control</intervention_name>
    <description>The Control group receives standard IV-inhaled general anesthesia.</description>
    <arm_group_label>Control</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Consent&#xD;
&#xD;
          -  ASA 1-3&#xD;
&#xD;
          -  No contraindication to epidural or ropivacaine&#xD;
&#xD;
          -  First time surgery for current conditions&#xD;
&#xD;
          -  Not on chronic pain medications or sedative&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  The subject has a known or suspected allergy to opioid analgesics or ropivacaine&#xD;
&#xD;
          -  Emergency patients&#xD;
&#xD;
          -  The subject has know central nervous system disease or neurological impairment&#xD;
&#xD;
          -  The subject has preoperative infection, and a history of immune and endocrine system&#xD;
             disease, chemotherapy, or blood transfusion.&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>75 Years</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Guoqing Zhao, doctor</last_name>
    <role>Principal Investigator</role>
    <affiliation>Jilin University</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>China-Japan Union Hospital of Jilin University</name>
      <address>
        <city>Changchun</city>
        <state>Jilin</state>
        <zip>130000</zip>
        <country>China</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>China</country>
  </location_countries>
  <verification_date>December 2017</verification_date>
  <study_first_submitted>January 13, 2017</study_first_submitted>
  <study_first_submitted_qc>January 26, 2017</study_first_submitted_qc>
  <study_first_posted type="Estimate">January 30, 2017</study_first_posted>
  <results_first_submitted>August 16, 2017</results_first_submitted>
  <results_first_submitted_qc>November 9, 2017</results_first_submitted_qc>
  <results_first_posted type="Actual">December 15, 2017</results_first_posted>
  <last_update_submitted>December 20, 2017</last_update_submitted>
  <last_update_submitted_qc>December 20, 2017</last_update_submitted_qc>
  <last_update_posted type="Actual">January 23, 2018</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Jilin University</investigator_affiliation>
    <investigator_full_name>Zhao Guoqing</investigator_full_name>
    <investigator_title>Clinical Professor</investigator_title>
  </responsible_party>
  <keyword>transversus abdominal plane block</keyword>
  <keyword>epidural anesthesia</keyword>
  <keyword>stress response</keyword>
  <keyword>anesthetic recovery</keyword>
  <intervention_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Anesthetics</mesh_term>
  </intervention_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <provided_document_section>
    <provided_document>
      <document_type>Study Protocol</document_type>
      <document_has_protocol>Yes</document_has_protocol>
      <document_has_icf>No</document_has_icf>
      <document_has_sap>No</document_has_sap>
      <document_date>January 30, 2017</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/16/NCT03035916/Prot_000.pdf</document_url>
    </provided_document>
    <provided_document>
      <document_type>Statistical Analysis Plan</document_type>
      <document_has_protocol>No</document_has_protocol>
      <document_has_icf>No</document_has_icf>
      <document_has_sap>Yes</document_has_sap>
      <document_date>January 30, 2017</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/16/NCT03035916/SAP_001.pdf</document_url>
    </provided_document>
    <provided_document>
      <document_type>Informed Consent Form</document_type>
      <document_has_protocol>No</document_has_protocol>
      <document_has_icf>Yes</document_has_icf>
      <document_has_sap>No</document_has_sap>
      <document_date>January 30, 2017</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/16/NCT03035916/ICF_002.pdf</document_url>
    </provided_document>
  </provided_document_section>

  <clinical_results>

    <participant_flow>
      <pre_assignment_details>According to the analysis by PASS 11.0, at lease 25 participants each arm were needed.Taking into account the withdrawal of patients in the middle of the study, each group were more than a few included</pre_assignment_details>
      <group_list>
        <group group_id="P1">
          <title>Transversus Abdominis Plane Block</title>
          <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
        </group>
        <group group_id="P2">
          <title>Epidural Anesthesia</title>
          <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
        </group>
        <group group_id="P3">
          <title>Control</title>
          <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
        </group>
      </group_list>
      <period_list>
        <period>
          <title>Overall Study</title>
          <milestone_list>
            <milestone>
              <title>STARTED</title>
              <participants_list>
                <participants group_id="P1" count="30"/>
                <participants group_id="P2" count="30"/>
                <participants group_id="P3" count="31"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="30"/>
                <participants group_id="P2" count="28"/>
                <participants group_id="P3" count="31"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>NOT COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="0"/>
                <participants group_id="P2" count="2"/>
                <participants group_id="P3" count="0"/>
              </participants_list>
            </milestone>
          </milestone_list>
          <drop_withdraw_reason_list>
            <drop_withdraw_reason>
              <title>Puncture failed</title>
              <participants_list>
                <participants group_id="P1" count="0"/>
                <participants group_id="P2" count="2"/>
                <participants group_id="P3" count="0"/>
              </participants_list>
            </drop_withdraw_reason>
          </drop_withdraw_reason_list>
        </period>
      </period_list>
    </participant_flow>

    <baseline>
      <group_list>
        <group group_id="B1">
          <title>Transversus Abdominis Plane Block</title>
          <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
        </group>
        <group group_id="B2">
          <title>Epidural Anesthesia</title>
          <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
        </group>
        <group group_id="B3">
          <title>Control</title>
          <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
        </group>
        <group group_id="B4">
          <title>Total</title>
          <description>Total of all reporting groups</description>
        </group>
      </group_list>
      <analyzed_list>
        <analyzed>
          <units>Participants</units>
          <scope>Overall</scope>
          <count_list>
            <count group_id="B1" value="30"/>
            <count group_id="B2" value="28"/>
            <count group_id="B3" value="31"/>
            <count group_id="B4" value="89"/>
          </count_list>
        </analyzed>
      </analyzed_list>
      <measure_list>
        <measure>
          <title>Age</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>&lt;=18 years</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="0"/>
                    <measurement group_id="B4" value="0"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Between 18 and 65 years</title>
                  <measurement_list>
                    <measurement group_id="B1" value="22"/>
                    <measurement group_id="B2" value="20"/>
                    <measurement group_id="B3" value="21"/>
                    <measurement group_id="B4" value="63"/>
                  </measurement_list>
                </category>
                <category>
                  <title>&gt;=65 years</title>
                  <measurement_list>
                    <measurement group_id="B1" value="8"/>
                    <measurement group_id="B2" value="8"/>
                    <measurement group_id="B3" value="10"/>
                    <measurement group_id="B4" value="26"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Age</title>
          <units>years</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="56.75" spread="8.24"/>
                    <measurement group_id="B2" value="58.60" spread="8.72"/>
                    <measurement group_id="B3" value="60.20" spread="9.43"/>
                    <measurement group_id="B4" value="59.18" spread="9.02"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Sex: Female, Male</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>Female</title>
                  <measurement_list>
                    <measurement group_id="B1" value="9"/>
                    <measurement group_id="B2" value="8"/>
                    <measurement group_id="B3" value="8"/>
                    <measurement group_id="B4" value="25"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Male</title>
                  <measurement_list>
                    <measurement group_id="B1" value="21"/>
                    <measurement group_id="B2" value="20"/>
                    <measurement group_id="B3" value="23"/>
                    <measurement group_id="B4" value="64"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Race/Ethnicity, Customized</title>
          <units>participants</units>
          <param>Number</param>
          <class_list>
            <class>
              <title>Asian</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="30"/>
                    <measurement group_id="B2" value="28"/>
                    <measurement group_id="B3" value="31"/>
                    <measurement group_id="B4" value="89"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>ASA physical status</title>
          <description>ASA I: No organic, physiologic, biochemical or psychiatric disturbance; ASA II: A patient with mild systemic disease that results in no functional limitation; ASA III: A patient with severe systemic disease that results in functional impairment; ASA IV: Severe systemic disease that is a constant threat to life; ASA V: Moribund condition in a patient who is not expected to survive with or without the operation; ASA VI: Declared brain death patient whose organs are being harvested for transplantation; E: Emergency operation is required.</description>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>I</title>
                  <measurement_list>
                    <measurement group_id="B1" value="5"/>
                    <measurement group_id="B2" value="4"/>
                    <measurement group_id="B3" value="4"/>
                    <measurement group_id="B4" value="13"/>
                  </measurement_list>
                </category>
                <category>
                  <title>II</title>
                  <measurement_list>
                    <measurement group_id="B1" value="19"/>
                    <measurement group_id="B2" value="18"/>
                    <measurement group_id="B3" value="20"/>
                    <measurement group_id="B4" value="57"/>
                  </measurement_list>
                </category>
                <category>
                  <title>III</title>
                  <measurement_list>
                    <measurement group_id="B1" value="6"/>
                    <measurement group_id="B2" value="6"/>
                    <measurement group_id="B3" value="7"/>
                    <measurement group_id="B4" value="19"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </measure_list>
    </baseline>

    <outcome_list>
      <outcome>
        <type>Primary</type>
        <title>Physiological Parameters: Plasma Concentration of Norepinephrine (NE)</title>
        <description>Venous blood samples will be collected at certain time points. The blood samples are collected in a pre-chilled tubes in ice and are centrifuged within 90min, and then separated plasma are stored at -80°C until analysis. The NE levels are measured by ELISA kits.</description>
        <time_frame>up to 48h after surgery</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Transversus Abdominis Plane Block</title>
            <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
          </group>
          <group group_id="O2">
            <title>Epidural Anesthesia</title>
            <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
          </group>
          <group group_id="O3">
            <title>Control</title>
            <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
          </group>
        </group_list>
        <measure>
          <title>Physiological Parameters: Plasma Concentration of Norepinephrine (NE)</title>
          <description>Venous blood samples will be collected at certain time points. The blood samples are collected in a pre-chilled tubes in ice and are centrifuged within 90min, and then separated plasma are stored at -80°C until analysis. The NE levels are measured by ELISA kits.</description>
          <units>pg/ml</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="30"/>
                <count group_id="O2" value="28"/>
                <count group_id="O3" value="31"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Baseline</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="145.6" spread="25.8"/>
                    <measurement group_id="O2" value="150.9" spread="33.2"/>
                    <measurement group_id="O3" value="153.1" spread="35.2"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>0 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="170.2" spread="33.4"/>
                    <measurement group_id="O2" value="165.5" spread="36.6"/>
                    <measurement group_id="O3" value="177.9" spread="43.2"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="172.3" spread="32.7"/>
                    <measurement group_id="O2" value="163.2" spread="32.4"/>
                    <measurement group_id="O3" value="215.5" spread="50.3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>24 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="150.5" spread="30.9"/>
                    <measurement group_id="O2" value="155.8" spread="25.3"/>
                    <measurement group_id="O3" value="175.4" spread="40.2"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>48 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="135.7" spread="29.8"/>
                    <measurement group_id="O2" value="140.6" spread="24.8"/>
                    <measurement group_id="O3" value="165.2" spread="32.7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of norepinephrine(NE) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.454</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of norepinephrine(NE) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.402</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of norepinephrine(NE) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.901</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of norepinephrine(NE) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;0 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.540</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of norepinephrine(NE) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;0 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.523</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of norepinephrine(NE) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;0 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.260</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of norepinephrine(NE) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.139</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of norepinephrine(NE) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of norepinephrine(NE) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of norepinephrine(NE) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.464</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of norepinephrine(NE) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.007</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of norepinephrine(NE) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of norepinephrine(NE) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.411</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of norepinephrine(NE) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of norepinephrine(NE) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Physiological Parameters: Plasma Concentration of Epinephrine (E)</title>
        <description>Venous blood samples will be collected at certain time points. The blood samples are collected in a pre-chilled tubes in ice and are centrifuged within 90min, and then separated plasma are stored at -80°C until analysis. The E levels are measured by ELISA kits.</description>
        <time_frame>up to 48h after surgery</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Transversus Abdominis Plane Block</title>
            <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
          </group>
          <group group_id="O2">
            <title>Epidural Anesthesia</title>
            <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
          </group>
          <group group_id="O3">
            <title>Control</title>
            <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
          </group>
        </group_list>
        <measure>
          <title>Physiological Parameters: Plasma Concentration of Epinephrine (E)</title>
          <description>Venous blood samples will be collected at certain time points. The blood samples are collected in a pre-chilled tubes in ice and are centrifuged within 90min, and then separated plasma are stored at -80°C until analysis. The E levels are measured by ELISA kits.</description>
          <units>pg/ml</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="30"/>
                <count group_id="O2" value="28"/>
                <count group_id="O3" value="31"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Baseline</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="33.2" spread="6"/>
                    <measurement group_id="O2" value="35" spread="5.4"/>
                    <measurement group_id="O3" value="34.4" spread="6.1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>0 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="41.5" spread="6.6"/>
                    <measurement group_id="O2" value="40.5" spread="7.2"/>
                    <measurement group_id="O3" value="42.2" spread="7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="45.3" spread="8.2"/>
                    <measurement group_id="O2" value="46.4" spread="7.5"/>
                    <measurement group_id="O3" value="52.3" spread="8.1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>24 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="44.5" spread="7"/>
                    <measurement group_id="O2" value="41.8" spread="6.2"/>
                    <measurement group_id="O3" value="59.1" spread="8.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>48 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="40.6" spread="6.3"/>
                    <measurement group_id="O2" value="39.3" spread="5.2"/>
                    <measurement group_id="O3" value="48.7" spread="7.6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of epinephrine (E) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.412</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of epinephrine (E) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.592</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of epinephrine (E) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.796</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of epinephrine (E) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;0 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.576</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of epinephrine (E) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;0 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.427</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of epinephrine (E) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;0 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.201</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of epinephrine (E) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.872</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of epinephrine (E) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of epinephrine (E) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of epinephrine (E) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.165</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of epinephrine (E) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of epinephrine (E) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of epinephrine (E) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.305</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of epinephrine (E) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of epinephrine (E) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control. This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Physiological Parameters: Plasma Concentration of Cortisol (Cor)</title>
        <description>Venous blood samples will be collected at certain time points. The blood samples are collected in a pre-chilled tubes in ice and are centrifuged within 90min, and then separated plasma are stored at -80°C until analysis. The Cor levels are measured by ELISA kits.</description>
        <time_frame>up to 48h after surgery</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Transversus Abdominis Plane Block</title>
            <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
          </group>
          <group group_id="O2">
            <title>Epidural Anesthesia</title>
            <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
          </group>
          <group group_id="O3">
            <title>Control</title>
            <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
          </group>
        </group_list>
        <measure>
          <title>Physiological Parameters: Plasma Concentration of Cortisol (Cor)</title>
          <description>Venous blood samples will be collected at certain time points. The blood samples are collected in a pre-chilled tubes in ice and are centrifuged within 90min, and then separated plasma are stored at -80°C until analysis. The Cor levels are measured by ELISA kits.</description>
          <units>mmol/L</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="30"/>
                <count group_id="O2" value="28"/>
                <count group_id="O3" value="31"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Baseline</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="273.3" spread="93"/>
                    <measurement group_id="O2" value="262.4" spread="101.5"/>
                    <measurement group_id="O3" value="286.3" spread="106.6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>0 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="430.4" spread="152.1"/>
                    <measurement group_id="O2" value="395.2" spread="133.4"/>
                    <measurement group_id="O3" value="516.1" spread="162.3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="519.2" spread="156.6"/>
                    <measurement group_id="O2" value="464.2" spread="155.8"/>
                    <measurement group_id="O3" value="698.3" spread="188.1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>24 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="439" spread="116"/>
                    <measurement group_id="O2" value="388.1" spread="121.2"/>
                    <measurement group_id="O3" value="713.8" spread="190"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>48 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="320.6" spread="112.3"/>
                    <measurement group_id="O2" value="302.8" spread="112.4"/>
                    <measurement group_id="O3" value="452.4" spread="165.3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of cortisol (Cor) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.673</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of cortisol (Cor) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.824</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of cortisol (Cor) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.547</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of cortisol (Cor) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;0 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.303</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of cortisol (Cor) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;0 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.026</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of cortisol (Cor) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;0 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.002</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of cortisol (Cor) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.057</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of cortisol (Cor) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of cortisol (Cor) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of cortisol (Cor) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.069</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of cortisol (Cor) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of cortisol (Cor) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of cortisol (Cor) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.561</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of cortisol (Cor) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of cortisol (Cor) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Physiological Parameters: Plasma Concentration of Glucose (Glu)</title>
        <description>When venous blood are collected, glucose levels are measured immediately by Glucometer.</description>
        <time_frame>up to 48h after surgery</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Transversus Abdominis Plane Block</title>
            <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
          </group>
          <group group_id="O2">
            <title>Epidural Anesthesia</title>
            <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
          </group>
          <group group_id="O3">
            <title>Control</title>
            <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
          </group>
        </group_list>
        <measure>
          <title>Physiological Parameters: Plasma Concentration of Glucose (Glu)</title>
          <description>When venous blood are collected, glucose levels are measured immediately by Glucometer.</description>
          <units>mmol/L</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="30"/>
                <count group_id="O2" value="28"/>
                <count group_id="O3" value="31"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Baseline</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5" spread="0.5"/>
                    <measurement group_id="O2" value="5.2" spread="0.5"/>
                    <measurement group_id="O3" value="5.5" spread="0.4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>0 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="8.2" spread="1.2"/>
                    <measurement group_id="O2" value="7.7" spread="0.9"/>
                    <measurement group_id="O3" value="10.5" spread="1.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="7.5" spread="1"/>
                    <measurement group_id="O2" value="7" spread="0.9"/>
                    <measurement group_id="O3" value="10.8" spread="1.9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>24 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="6.5" spread="0.8"/>
                    <measurement group_id="O2" value="6.3" spread="0.7"/>
                    <measurement group_id="O3" value="8.6" spread="1.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>48 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5.5" spread="0.4"/>
                    <measurement group_id="O2" value="5.2" spread="0.5"/>
                    <measurement group_id="O3" value="5.8" spread="0.6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.249</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.091</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.493</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;0 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.067</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;0 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;0 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.079</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.314</p_value>
            <p_value_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</p_value_desc>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.087</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.023</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The plasma level of glucose (Glu) were detected from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Hemodynamic Parameters: Heart Rate.</title>
        <description>Continuous monitoring of heart rate to 48 hours after surgery.</description>
        <time_frame>up to 48h after surgery</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Transversus Abdominis Plane Block</title>
            <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
          </group>
          <group group_id="O2">
            <title>Epidural Anesthesia</title>
            <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
          </group>
          <group group_id="O3">
            <title>Control</title>
            <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
          </group>
        </group_list>
        <measure>
          <title>Hemodynamic Parameters: Heart Rate.</title>
          <description>Continuous monitoring of heart rate to 48 hours after surgery.</description>
          <units>bpm</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="30"/>
                <count group_id="O2" value="28"/>
                <count group_id="O3" value="31"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Baseline</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="75.4" spread="12.5"/>
                    <measurement group_id="O2" value="77.1" spread="11.1"/>
                    <measurement group_id="O3" value="76.4" spread="12"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Before induction</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="74.8" spread="10.9"/>
                    <measurement group_id="O2" value="70" spread="12.2"/>
                    <measurement group_id="O3" value="76" spread="11"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Induction</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="71.1" spread="10.8"/>
                    <measurement group_id="O2" value="63.1" spread="10.3"/>
                    <measurement group_id="O3" value="71.7" spread="10.2"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Intubation</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="88.4" spread="11.5"/>
                    <measurement group_id="O2" value="87" spread="13"/>
                    <measurement group_id="O3" value="92" spread="13.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Incision</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="80" spread="11.4"/>
                    <measurement group_id="O2" value="78" spread="11.5"/>
                    <measurement group_id="O3" value="95.7" spread="13.3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Extubation</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="82" spread="13.5"/>
                    <measurement group_id="O2" value="80" spread="13"/>
                    <measurement group_id="O3" value="85" spread="15"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="77" spread="10.5"/>
                    <measurement group_id="O2" value="75" spread="10"/>
                    <measurement group_id="O3" value="79" spread="12"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>24 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="75" spread="10.9"/>
                    <measurement group_id="O2" value="74" spread="11"/>
                    <measurement group_id="O3" value="81.3" spread="10.8"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>48 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="75.8" spread="10.3"/>
                    <measurement group_id="O2" value="75" spread="10.5"/>
                    <measurement group_id="O3" value="79.5" spread="11.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.384</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.530</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.819</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Before induction&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.108</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Before induction&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.667</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Before induction&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.046</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Induction&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.006</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Induction&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.406</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Induction&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.042</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Intubation&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.655</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Intubation&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.262</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Intubation&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.143</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Incision&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.494</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Incision&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Incision&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Extubation&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.555</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Extubation&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.411</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Extubation&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.167</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.445</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.489</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.159</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.720</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.026</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.011</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.763</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.187</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The Heart rate was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.112</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Hemodynamic Parameters: Mean Arterial Pressure(MAP)</title>
        <description>Continuous monitoring of mean arterial pressure(MAP) to 48 hours after surgery. mean arterial pressure(MAP)＝ (systolic blood pressure＋2×diastolic blood pressure)/3</description>
        <time_frame>up to 48h after surgery</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Transversus Abdominis Plane Block</title>
            <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
          </group>
          <group group_id="O2">
            <title>Epidural Anesthesia</title>
            <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
          </group>
          <group group_id="O3">
            <title>Control</title>
            <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
          </group>
        </group_list>
        <measure>
          <title>Hemodynamic Parameters: Mean Arterial Pressure(MAP)</title>
          <description>Continuous monitoring of mean arterial pressure(MAP) to 48 hours after surgery. mean arterial pressure(MAP)＝ (systolic blood pressure＋2×diastolic blood pressure)/3</description>
          <units>mmHg</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="30"/>
                <count group_id="O2" value="28"/>
                <count group_id="O3" value="31"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Baseline</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="87" spread="12.5"/>
                    <measurement group_id="O2" value="88.5" spread="11"/>
                    <measurement group_id="O3" value="86" spread="12"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Before induction</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="90" spread="13"/>
                    <measurement group_id="O2" value="80" spread="12"/>
                    <measurement group_id="O3" value="87" spread="13"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Induction</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="81" spread="10.5"/>
                    <measurement group_id="O2" value="73" spread="12"/>
                    <measurement group_id="O3" value="80" spread="13"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Intubation</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="93" spread="13.5"/>
                    <measurement group_id="O2" value="90" spread="15"/>
                    <measurement group_id="O3" value="94" spread="15.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Incision</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="85" spread="12"/>
                    <measurement group_id="O2" value="84" spread="11.5"/>
                    <measurement group_id="O3" value="98" spread="15"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Extubation</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="88" spread="13.5"/>
                    <measurement group_id="O2" value="90" spread="13"/>
                    <measurement group_id="O3" value="95" spread="15"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="89" spread="10.5"/>
                    <measurement group_id="O2" value="86" spread="10"/>
                    <measurement group_id="O3" value="93" spread="12"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>24 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="88" spread="12.5"/>
                    <measurement group_id="O2" value="84" spread="11"/>
                    <measurement group_id="O3" value="90" spread="14"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>48 hr after surgery</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="89" spread="12"/>
                    <measurement group_id="O2" value="85" spread="10.5"/>
                    <measurement group_id="O3" value="90" spread="11.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.645</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.645</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Baseline&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.314</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Before induction&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.003</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Before induction&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.367</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Before induction&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.031</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Induction&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.009</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Induction&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.873</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Induction&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.026</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Intubation&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.411</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Intubation&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.787</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Intubation&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.306</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Incision&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.921</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Incision&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Incision&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Extubation&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.555</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Extubation&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.058</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;Extubation&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.166</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.288</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.299</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.051</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.186</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.555</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.065</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.168</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.739</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The mean arterial pressure(MAP) was measured from baseline to 48hours after surgery. The row &quot;Baseline&quot; is the preoperative level as the blank control.This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.079</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Anesthetics Consumption: Sufentanil Consumption</title>
        <description>Intraoperative superaddition of sufentanil was measured.</description>
        <time_frame>during operation</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Transversus Abdominis Plane Block</title>
            <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
          </group>
          <group group_id="O2">
            <title>Epidural Anesthesia</title>
            <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
          </group>
          <group group_id="O3">
            <title>Control</title>
            <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
          </group>
        </group_list>
        <measure>
          <title>Anesthetics Consumption: Sufentanil Consumption</title>
          <description>Intraoperative superaddition of sufentanil was measured.</description>
          <units>ug</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="30"/>
                <count group_id="O2" value="28"/>
                <count group_id="O3" value="31"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="4.3" spread="1.5"/>
                    <measurement group_id="O2" value="3.6" spread="1.2"/>
                    <measurement group_id="O3" value="10.2" spread="2.8"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.056</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Questionnaire: Pain Scores at Rest</title>
        <description>Pain scores of the participants will be measured by the Visual Analogue Scale. Measurement of VAS: Draw a 10cm horizontal line on the paper. The VAS were anchored at 0cm(no pain) and 10cm(worst possible pain), the middle part shows varying degrees of pain, the greater of the number, the worse of the pain.</description>
        <time_frame>1hr, 6hr, 12hr, 24hr, and 48hr after surgery</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Transversus Abdominis Plane Block</title>
            <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
          </group>
          <group group_id="O2">
            <title>Epidural Anesthesia</title>
            <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
          </group>
          <group group_id="O3">
            <title>Control</title>
            <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
          </group>
        </group_list>
        <measure>
          <title>Questionnaire: Pain Scores at Rest</title>
          <description>Pain scores of the participants will be measured by the Visual Analogue Scale. Measurement of VAS: Draw a 10cm horizontal line on the paper. The VAS were anchored at 0cm(no pain) and 10cm(worst possible pain), the middle part shows varying degrees of pain, the greater of the number, the worse of the pain.</description>
          <units>units on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="30"/>
                <count group_id="O2" value="28"/>
                <count group_id="O3" value="31"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>1 hr</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.2" spread="0.7"/>
                    <measurement group_id="O2" value="1.8" spread="1.0"/>
                    <measurement group_id="O3" value="2.7" spread="0.6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6 hr</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.2" spread="0.9"/>
                    <measurement group_id="O2" value="1.9" spread="0.8"/>
                    <measurement group_id="O3" value="2.7" spread="1.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>12 hr</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.0" spread="0.7"/>
                    <measurement group_id="O2" value="1.7" spread="0.7"/>
                    <measurement group_id="O3" value="2.8" spread="1.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>24 hr</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.2" spread="0.6"/>
                    <measurement group_id="O2" value="1.3" spread="0.6"/>
                    <measurement group_id="O3" value="2.7" spread="1.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>48 hr</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.0" spread="0.8"/>
                    <measurement group_id="O2" value="0.9" spread="0.6"/>
                    <measurement group_id="O3" value="1.3" spread="0.8"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;1 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.056</p_value>
            <p_value_desc>p&lt;0.05 indicates that the data difference is statistically significant.</p_value_desc>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;1 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.009</p_value>
            <p_value_desc>p&lt;0.05 indicates that the data difference is statistically significant.</p_value_desc>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;1 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <p_value_desc>p&lt;0.05 indicates that the data difference is statistically significant.</p_value_desc>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.198</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.047</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.002</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;12 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.102</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;12 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.005</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;12 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.023</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.425</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.124</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.052</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Questionnaire: Pain Scores on Movement</title>
        <description>Pain scores of the participants will be measured by the Visual Analogue Scale. Measurement of VAS: Draw a 10cm horizontal line on the paper. The VAS were anchored at 0cm(no pain) and 10cm(worst possible pain), the middle part shows varying degrees of pain, the greater of the number, the worse of the pain.</description>
        <time_frame>1hr, 6hr, 12hr, 24hr, and 48hr after surgery</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Transversus Abdominis Plane Block</title>
            <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
          </group>
          <group group_id="O2">
            <title>Epidural Anesthesia</title>
            <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
          </group>
          <group group_id="O3">
            <title>Control</title>
            <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
          </group>
        </group_list>
        <measure>
          <title>Questionnaire: Pain Scores on Movement</title>
          <description>Pain scores of the participants will be measured by the Visual Analogue Scale. Measurement of VAS: Draw a 10cm horizontal line on the paper. The VAS were anchored at 0cm(no pain) and 10cm(worst possible pain), the middle part shows varying degrees of pain, the greater of the number, the worse of the pain.</description>
          <units>units on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="30"/>
                <count group_id="O2" value="28"/>
                <count group_id="O3" value="31"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>1 hr</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.7" spread="1.2"/>
                    <measurement group_id="O2" value="2.4" spread="1.1"/>
                    <measurement group_id="O3" value="4.3" spread="0.8"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6 hr</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.9" spread="0.7"/>
                    <measurement group_id="O2" value="2.6" spread="1.3"/>
                    <measurement group_id="O3" value="4.2" spread="0.7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>12 hr</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.3" spread="0.5"/>
                    <measurement group_id="O2" value="3.7" spread="0.9"/>
                    <measurement group_id="O3" value="4.0" spread="0.8"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>24 hr</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="4.1" spread="0.7"/>
                    <measurement group_id="O2" value="3.5" spread="0.9"/>
                    <measurement group_id="O3" value="4.6" spread="0.8"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>48 hr</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="4.2" spread="0.8"/>
                    <measurement group_id="O2" value="3.5" spread="0.8"/>
                    <measurement group_id="O3" value="4.5" spread="0.9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;1 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.176</p_value>
            <p_value_desc>p&lt;0.05 indicates that the data difference is statistically significant.</p_value_desc>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;1 hour after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <p_value_desc>p&lt;0.05 indicates that the data difference is statistically significant.</p_value_desc>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.228</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;6 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;12 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.057</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;12 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;12 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.004</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.005</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;24 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.002</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.002</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <groups_desc>The pain score were measured from 1 hour to 48hours after surgery. This Statistical Analysis applied to &quot;48 hours after surgery&quot; row.</groups_desc>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.001</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Anesthesia Recovery: the Time of First Flatus</title>
        <description>The time of first flatus was measured after surgery.</description>
        <time_frame>Through study completion, an average of 2 weeks</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Transversus Abdominis Plane Block</title>
            <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
          </group>
          <group group_id="O2">
            <title>Epidural Anesthesia</title>
            <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
          </group>
          <group group_id="O3">
            <title>Control</title>
            <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
          </group>
        </group_list>
        <measure>
          <title>Anesthesia Recovery: the Time of First Flatus</title>
          <description>The time of first flatus was measured after surgery.</description>
          <units>hour</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="30"/>
                <count group_id="O2" value="28"/>
                <count group_id="O3" value="31"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="77.6" spread="10.4"/>
                    <measurement group_id="O2" value="78.4" spread="11.6"/>
                    <measurement group_id="O3" value="81.6" spread="10.4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.585</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.071</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.13</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Anesthesia Recovery: Number of Participants With Prolonged Hospitalization</title>
        <description>The percentage of long hospitalization were measured. More than 7 days after surgery is defined as prolonged hospitalization.</description>
        <time_frame>Through study completion, an average of 2 weeks</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Transversus Abdominis Plane Block</title>
            <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
          </group>
          <group group_id="O2">
            <title>Epidural Anesthesia</title>
            <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
          </group>
          <group group_id="O3">
            <title>Control</title>
            <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
          </group>
        </group_list>
        <measure>
          <title>Anesthesia Recovery: Number of Participants With Prolonged Hospitalization</title>
          <description>The percentage of long hospitalization were measured. More than 7 days after surgery is defined as prolonged hospitalization.</description>
          <units>participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="30"/>
                <count group_id="O2" value="28"/>
                <count group_id="O3" value="31"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5"/>
                    <measurement group_id="O2" value="5"/>
                    <measurement group_id="O3" value="13"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.644</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.045</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.031</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Side Effects: Number of Participants With Sedation</title>
        <description>The state of sedation was evaluated after surgery during first postoperative 48 hours.</description>
        <time_frame>up to 48h after surgery</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Transversus Abdominis Plane Block</title>
            <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
          </group>
          <group group_id="O2">
            <title>Epidural Anesthesia</title>
            <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
          </group>
          <group group_id="O3">
            <title>Control</title>
            <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
          </group>
        </group_list>
        <measure>
          <title>Side Effects: Number of Participants With Sedation</title>
          <description>The state of sedation was evaluated after surgery during first postoperative 48 hours.</description>
          <units>participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="30"/>
                <count group_id="O2" value="28"/>
                <count group_id="O3" value="31"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="8"/>
                    <measurement group_id="O2" value="5"/>
                    <measurement group_id="O3" value="16"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.421</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.046</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.007</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Side Effects: Number of Participants With Nausea</title>
        <description>The state of nausea was evaluated after surgery during first postoperative 48 hours.</description>
        <time_frame>up to 48h after surgery</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Transversus Abdominis Plane Block</title>
            <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
          </group>
          <group group_id="O2">
            <title>Epidural Anesthesia</title>
            <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
          </group>
          <group group_id="O3">
            <title>Control</title>
            <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
          </group>
        </group_list>
        <measure>
          <title>Side Effects: Number of Participants With Nausea</title>
          <description>The state of nausea was evaluated after surgery during first postoperative 48 hours.</description>
          <units>participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="30"/>
                <count group_id="O2" value="28"/>
                <count group_id="O3" value="31"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5"/>
                    <measurement group_id="O2" value="4"/>
                    <measurement group_id="O3" value="6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.910</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.864</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.785</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Side Effects: Number of Participants With Vomiting</title>
        <description>The state of vomiting was evaluated after surgery during first postoperative 48 hours.</description>
        <time_frame>up to 48h after surgery</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Transversus Abdominis Plane Block</title>
            <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
          </group>
          <group group_id="O2">
            <title>Epidural Anesthesia</title>
            <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
          </group>
          <group group_id="O3">
            <title>Control</title>
            <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
          </group>
        </group_list>
        <measure>
          <title>Side Effects: Number of Participants With Vomiting</title>
          <description>The state of vomiting was evaluated after surgery during first postoperative 48 hours.</description>
          <units>participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="30"/>
                <count group_id="O2" value="28"/>
                <count group_id="O3" value="31"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0"/>
                    <measurement group_id="O2" value="1"/>
                    <measurement group_id="O3" value="1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.972</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.987</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O2</group_id>
              <group_id>O3</group_id>
            </group_id_list>
            <non_inferiority_type>Other</non_inferiority_type>
            <p_value>0.518</p_value>
            <method>t-test, 2 sided</method>
          </analysis>
        </analysis_list>
      </outcome>
    </outcome_list>

    <reported_events>
      <time_frame>1 month</time_frame>
      <group_list>
        <group group_id="E1">
          <title>Transversus Abdominis Plane Block</title>
          <description>The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.&#xD;
Transversus abdominis plane block: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.</description>
        </group>
        <group group_id="E2">
          <title>Epidural Anesthesia</title>
          <description>The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.&#xD;
Epidural anesthesia: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.</description>
        </group>
        <group group_id="E3">
          <title>Control</title>
          <description>The Control group receives standard IV-inhaled general anesthesia.&#xD;
control: The Control group receives standard IV-inhaled general anesthesia.</description>
        </group>
      </group_list>
      <serious_events>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, all-cause mortality</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="30"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="28"/>
                <counts group_id="E3" subjects_affected="0" subjects_at_risk="31"/>
              </event>
              <event>
                <sub_title>Total, serious adverse events</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="30"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="28"/>
                <counts group_id="E3" subjects_affected="0" subjects_at_risk="31"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </serious_events>
      <other_events>
        <frequency_threshold>2</frequency_threshold>
        <default_assessment>Non-systematic Assessment</default_assessment>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, other adverse events</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="30"/>
                <counts group_id="E2" subjects_affected="2" subjects_at_risk="28"/>
                <counts group_id="E3" subjects_affected="0" subjects_at_risk="31"/>
              </event>
            </event_list>
          </category>
          <category>
            <title>Nervous system disorders</title>
            <event_list>
              <event>
                <sub_title>Headache</sub_title>
                <counts group_id="E1" events="0" subjects_affected="0" subjects_at_risk="30"/>
                <counts group_id="E2" events="2" subjects_affected="2" subjects_at_risk="28"/>
                <counts group_id="E3" events="0" subjects_affected="0" subjects_at_risk="31"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </other_events>
    </reported_events>

    <certain_agreements>
      <pi_employee>All Principal Investigators ARE employed by the organization sponsoring the study.</pi_employee>
      <restrictive_agreement>There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed. </restrictive_agreement>
    </certain_agreements>
    <limitations_and_caveats>Firstly, early termination leading to small numbers of subjects analyzed. Secondly, sufentanil for analgesia, known to have effects on neuroimmunoendocrine network, which may have influenced our finding.</limitations_and_caveats>
    <point_of_contact>
      <name_or_title>Dr. Guoqing Zhao</name_or_title>
      <organization>China-Japan Unit Hospital of Jilin University</organization>
      <phone>0435-84995117</phone>
      <email>zhaogq65@126.com</email>
    </point_of_contact>
  </clinical_results>
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03035916
org study id: 3D5l4L463430
secondary id: 3R210Z893430
nct id: NCT03035916
lead sponsor: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
This study evaluates the effect of transversus abdominis plane(TAP) block combined with
      general anesthesia on perioperative stress response in patients undergoing radical
      gastrectomy. One third of participants will receive TAP block combined with general
      anesthesia, another one third of participants will receive epidural anesthesia combined with
      general anesthesia, while the rest will receive only general anesthesia.
Clinically, combining epidural with general anaesthesia may confer many advantages to
      patients undergoing major thoracic, abdominal or orthopaedic surgery. Epidural anaesthesia
      can attenuate sympathetic hyperactivity and the stress response, maintain bowel peristalsis,
      spare the use of opioids, and facilitate postoperative feeding and physiotherapy. However,
      establishing epidural anesthesia is not without risks and contraindications, including
      refusal by the patient, technical failure, unintentional dural puncture, waist and back pain
      and local anaesthetic toxicity. When neurologic complications do occur, the resulting
      morbidity and mortality is considerable. Transversus abdominis plane (TAP) block, is another
      new regional anesthesia technique, has been introduced as an abdominal wall block capable of
      providing effective analgesia, reducing opioid consumption, and lessening opioid-related side
      effects. In addition,TAP block, somewhat as a pre-emptive analgesia approach, is a way of
      pain intervention before noxious stimulation which has been reported to be potent to
      attenuate the stress response. Although the analgesia efficiency of TAP block has been widely
      studied, its effectiveness to suppress stress response has little comparison with classic
      epidural block and general anesthesia. Unlike epidural anaesthesia, TAP block is easy to
      administer and lower incidence for side-effects.The investigators hypothesize that the TAP
      block reduces the stress response of surgery to the similar extent to epidural anaesthesia
      when combined with a standard general anaesthesia for abdominal surgery.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Treatment
masking: Double (Investigator, Outcomes Assessor)
measure: Physiological Parameters: Plasma Concentration of Norepinephrine (NE)
time frame: up to 48h after surgery
description: Venous blood samples will be collected at certain time points. The blood samples are collected in a pre-chilled tubes in ice and are centrifuged within 90min, and then separated plasma are stored at -80°C until analysis. The NE levels are measured by ELISA kits.
measure: Physiological Parameters: Plasma Concentration of Epinephrine (E)
time frame: up to 48h after surgery
description: Venous blood samples will be collected at certain time points. The blood samples are collected in a pre-chilled tubes in ice and are centrifuged within 90min, and then separated plasma are stored at -80°C until analysis. The E levels are measured by ELISA kits.
measure: Physiological Parameters: Plasma Concentration of Cortisol (Cor)
time frame: up to 48h after surgery
description: Venous blood samples will be collected at certain time points. The blood samples are collected in a pre-chilled tubes in ice and are centrifuged within 90min, and then separated plasma are stored at -80°C until analysis. The Cor levels are measured by ELISA kits.
measure: Physiological Parameters: Plasma Concentration of Glucose (Glu)
time frame: up to 48h after surgery
description: When venous blood are collected, glucose levels are measured immediately by Glucometer.
measure: Hemodynamic Parameters: Heart Rate.
time frame: up to 48h after surgery
description: Continuous monitoring of heart rate to 48 hours after surgery.
measure: Hemodynamic Parameters: Mean Arterial Pressure(MAP)
time frame: up to 48h after surgery
description: Continuous monitoring of mean arterial pressure(MAP) to 48 hours after surgery. mean arterial pressure(MAP)＝ (systolic blood pressure＋2×diastolic blood pressure)/3
measure: Anesthetics Consumption: Sufentanil Consumption
time frame: during operation
description: Intraoperative superaddition of sufentanil was measured.
measure: Questionnaire: Pain Scores at Rest
time frame: 1hr, 6hr, 12hr, 24hr, and 48hr after surgery
description: Pain scores of the participants will be measured by the Visual Analogue Scale. Measurement of VAS: Draw a 10cm horizontal line on the paper. The VAS were anchored at 0cm(no pain) and 10cm(worst possible pain), the middle part shows varying degrees of pain, the greater of the number, the worse of the pain.
measure: Questionnaire: Pain Scores on Movement
time frame: 1hr, 6hr, 12hr, 24hr, and 48hr after surgery
description: Pain scores of the participants will be measured by the Visual Analogue Scale. Measurement of VAS: Draw a 10cm horizontal line on the paper. The VAS were anchored at 0cm(no pain) and 10cm(worst possible pain), the middle part shows varying degrees of pain, the greater of the number, the worse of the pain.
measure: Anesthesia Recovery: the Time of First Flatus
time frame: Through study completion, an average of 2 weeks
description: The time of first flatus was measured after surgery.
measure: Anesthesia Recovery: Number of Participants With Prolonged Hospitalization
time frame: Through study completion, an average of 2 weeks
description: The percentage of long hospitalization were measured. More than 7 days after surgery is defined as prolonged hospitalization.
measure: Side Effects: Number of Participants With Sedation
time frame: up to 48h after surgery
description: The state of sedation was evaluated after surgery during first postoperative 48 hours.
measure: Side Effects: Number of Participants With Nausea
time frame: up to 48h after surgery
description: The state of nausea was evaluated after surgery during first postoperative 48 hours.
measure: Side Effects: Number of Participants With Vomiting
time frame: up to 48h after surgery
description: The state of vomiting was evaluated after surgery during first postoperative 48 hours.
arm group label: Transversus abdominis plane block
arm group type: Experimental
description: The TAP group receives ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia.
arm group label: Epidural anesthesia
arm group type: Active Comparator
description: The Epidural group receives epidural block (T8-9) 2 mL of 1.6% lidocaine as a test dose and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.
arm group label: Control
arm group type: Placebo Comparator
description: The Control group receives standard IV-inhaled general anesthesia.
intervention type: Other
intervention name: Transversus abdominis plane block
description: Participants in this group receive ultrasound-guided TAP block under bilateral costal margin with multiple injections of 40ml 0.375% ropivacaine after the induction of general anesthesia, 30 minutes later the surgery will be started.
arm group label: Transversus abdominis plane block
intervention type: Other
intervention name: Epidural anesthesia
description: Participants in the Epidural group receive a epidural block (T8-9) with 2 mL of 1.6% lidocaine as a test dose before induction. After a successful placement of epidural catheter, the block then is established with 5 mL of 0.375% ropivacaine and continous infusion of 0.375% ropivacaine(5 mL/h) during the surgery.
arm group label: Epidural anesthesia
intervention type: Other
intervention name: control
description: The Control group receives standard IV-inhaled general anesthesia.
arm group label: Control
criteria: 
gender: All
minimum age: 18 Years
maximum age: 75 Years
healthy volunteers: No
last name: Guoqing Zhao, doctor
role: Principal Investigator
affiliation: Jilin University
facility: 
country: China
responsible party type: Principal Investigator
investigator affiliation: Jilin University
investigator full name: Zhao Guoqing
investigator title: Clinical Professor
mesh term: Anesthetics
sharing ipd: No
provided document: 
provided document: 
provided document: 
participant flow: 
baseline: 
outcome list: 
reported events: 
certain agreements: 
limitations and caveats: Firstly, early termination leading to small numbers of subjects analyzed. Secondly, sufentanil for analgesia, known to have effects on neuroimmunoendocrine network, which may have influenced our finding.
point of contact: 