To explore the effects of a multimodal analgesia regimen combining pre-treatment with acetaminophen mannitol injection, acupuncture and transversus abdominis plane block（TAPB）on postoperative recovery in elderly patients after laparoscopic radical gastrectomy.

This study utilized a randomized controlled trial design, enrolling the elderly patients undergoing radical gastrectomy who were randomly assigned into three groups: the control group（TAPB group）, the acetaminophen +TAPB group, and the acupuncture +acetaminophen + TAPB group. Pretreatment with paracetamol mannitol injection was given before operation, and TAPB, acupuncture and moxibustion and combined treatment were performed after operation. The vital signs, pain scores, analgesic drug usage, postoperative recovery and incidence of adverse events within 48 hours after surgery were compared among the three groups.

Compared to the TAPB group, the acupuncture +acetaminophen + TAPB group demonstrated significant differences in postoperative heart rate recovery, blood pressure stability, control of visual analogue scale（VAS）scores, reduced postoperative analgesic consumption, earlier time to first ambulation, shortened time to first flatus and decreased incidence of postoperative delirium and shoulder pain（P<0.05）. The acetaminophen + TAPB group also showed advantages over the TAPB group in some indicators, but not as significantly as the acupuncture + acetaminophen + TAPB group.

The multimodal analgesia regimen of pretreatment with acetaminophen mannitol injection combined with acupuncture and TAPB significantly improves postoperative recovery in the elderly patients after laparoscopic radical gastrectomy. It effectively controls the postoperative pain, reduces the analgesic use, promotes the gastrointestinal function recovery and decreases the incidence of postoperative adverse events.