Ultrasound-guided bilateral subcostal transversus abdominis plane block in gastric cancer patients undergoing laparoscopic gastrectomy: a randomised-controlled double-blinded study.

Abstract

BACKGROUND:

The effectiveness of subcostal transversus abdominis plane block (TAPB) in laparoscopic gastric cancer surgery is unknown. We aimed to investigate its opioid-sparing and pain-relief effects in laparoscopic gastrectomy for gastric cancer.

METHOD:

One hundred and twelve patients undergoing elective laparoscopic gastrectomy were randomised to the TAPB or control group. The TAPB group received ultrasound-guided bilateral subcostal TAPB at the end of surgery, while the control group did not. We investigated fentanyl consumption administered via intravenous patient-controlled analgesia and as a rescue analgesic, the numeric rating scale (NRS) pain scores at rest and during coughing, and the opioid-related side effects at 6, 12, 24, and 48 h postoperatively. The primary outcome was cumulative fentanyl consumption at 24 h postoperatively.

RESULTS:

The study included 53 patients in each group. The cumulative fentanyl consumption 24 h postoperatively was significantly lower in the TAPB group than in the control group (median difference -170 mcg, P = 0.03, 95% CI -360 to -15 mcg). Subcostal TAPB also significantly reduced the resting NRS score at 48 h postoperatively (median difference -1, 95% CI -1 to 0, P = 0.01) and coughing NRS score at all time points (all median difference -1, 95% CI -2 to 0, P < 0.01, P  = 0.02, 0.01, and 0.01, respectively). However, it did not reduce the occurrence of opioid-related side effects, except the use of antiemetics during the first 6 h postoperatively (TAPB, 1.9% vs. Control, 15.1%, P = 0.03).

CONCLUSION:

Ultrasound-guided bilateral subcostal TAPB provides efficient postoperative analgesia with an opioid-sparing effect after laparoscopic gastrectomy.

• Authors: Susie Yoon, Gyu Young Song, Jihye Lee, Ho-Jin Lee, Seong-Ho Kong, Won Ho Kim, Do Joong Park, Hyuk-Joon Lee, Han-Kwang Yang
• Journal: Surgical endoscopy (Surg Endosc) Vol. 36 Issue 2 Pg. 1044-1052 (02 2022) ISSN: 1432-2218 [Electronic] Germany
• PMID: 33638105 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.

Chemical References

• Analgesics, Opioid

Topics

• Abdominal Muscles (diagnostic imaging)
• Analgesics, Opioid (therapeutic use)
• Gastrectomy
• Humans
• Laparoscopy
• Pain, Postoperative (drug therapy, etiology, prevention & control)
• Stomach Neoplasms (drug therapy, surgery)
• Ultrasonography, Interventional