Ultrasound-guided bilateral subcostal transversus abdominis plane block in gastric cancer patients undergoing laparoscopic gastrectomy: a randomised-controlled double-blinded study
- 26 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Surgical Endoscopy
- Vol. 36 (2), 1044-1052
- https://doi.org/10.1007/s00464-021-08370-9
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.Keywords
This publication has 33 references indexed in Scilit:
- Consensus Guidelines for the Management of Postoperative Nausea and VomitingAnesthesia & Analgesia, 2014
- The Analgesic Efficacy of Subcostal Transversus Abdominis Plane Block Compared with Thoracic Epidural Analgesia and Intravenous Opioid Analgesia After Radical GastrectomyAnesthesia & Analgesia, 2013
- Preoperative Dexamethasone Enhances Quality of Recovery after Laparoscopic CholecystectomyAnesthesiology, 2011
- The Clavien-Dindo Classification of Surgical ComplicationsAnnals of Surgery, 2009
- Cytokines, Inflammation, and PainInternational Anesthesiology Clinics, 2007
- Correlation of Postoperative Pain to Quality of Recovery in the Immediate Postoperative PeriodRegional Anesthesia & Pain Medicine, 2005
- Correlation of Postoperative Pain to Quality of Recovery in the Immediate Postoperative PeriodRegional Anesthesia & Pain Medicine, 2005
- The Relationship Between Movement-Evoked Versus Spontaneous Pain and Peak Expiratory Flow After Abdominal HysterectomyAnesthesia & Analgesia, 2002
- Local Anesthetics and the Inflammatory ResponseAnesthesiology, 2000