TAPB Combined With RSB Versus ESPB for Postoperative Analgesia After Laparoscopic Liver Resection

Study Overview
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Brief Summary
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Postoperative pain after laparoscopic hepatectomy is composed of multiple factors, and the peak pain of postoperative pain mainly occurs within the first 24 hours, so it is particularly important to find an appropriate analgesic method. Transversus abdominis plane block (TAPB) and Rectus sheath blocks (RSB) are widely used in abdominal surgery, but too deep a needle tip during RSB may puncture abdominal organs. TAPB and RSB can only provide somatic analgesia, but lack visceral analgesia. Recently, Erector spinae plane block (ESPB) has been used in some studies for analgesia after abdominal surgery. The purpose of this study is to compare the analgesic effect and postoperative recovery effect of erector spinae plane block and transverse abdominis plane block combined with rectus sheath block in patients undergoing laparoscopic hepatectomy. Therefore, this study has important clinical implications.

Detailed Description
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In a double-blind randomized controlled study, researchers randomized 60 patients undergoing laparoscopic hepatectomy to TAPB combined with RSB or ESPB, with both groups receiving additional standardized treatment, including multimodal analgesia. The main outcome was the consumption of morphine within 24 hours after surgery. Secondary outcomes included the number of rescue analgesia at 1h, 2h, 4h, 8h and 24 hours after surgery, VAS scores in resting and coughing at 1h, 2h, 4h, 8h and 24h after surgery, CVP values at 5, 10, 15 and 30min after nerve block, QoR-15 patient questionnaire scores before and 24h after surgery, and postoperative liver function (the percentage increase of AST and ALT compare with preoperative), postoperative complications and discharge time.

Official Title
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Transversus Abdominis Plane Block Combined With Rectus Sheath Block Versus Erector Spinae Plane Block for Postoperative Analgesia After Laparoscopic Liver Resection

Conditions
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Laparoscopic Hepatectomy, Nerve Block

Intervention / Treatment
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* Procedure: erector spinae plane block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA grades I-II; Age 18 70 years old; BMI 19～28kg/m2; Patients undergoing elective laparoscopic partial liver resection; Exclusion Criteria: The nerve block cannot be performed, such as skin infection at the puncture site; Daily using the opioid analgesics or have a history of opioid abuse; Allergy or a history of drug allergy to any of the drugs used in the study; Patients have cognitive impairment, mental or neurological diseases, motor or sensory deficits; Coagulation disorders; Severe lung, heart, liver, or kidney dysfunction; Participating in other clinical trials within 3 months before being included in this study;

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: ESPB<br>erector spinae plane block | Procedure: erector spinae plane block<br>* The experimental group received ultrasound-guided erector spinae plane block, and bilateral erector spinae plane block was performed at T7 segment with 20ml 0.375% ropivacaine on each side.While the control group received ultrasound-guided transversus abdominis plane block combined with rectus sheath block, which will be performed under the costal margin with 10ml 0.375% ropivacaine for bilateral transversus abdominis plane block and 10ml 0.375% ropivacaine for bilateral rectus sheath block.<br>* Other names: transversus abdominis plane block combined with rectus sheath block;|
| Active Comparator: TAPB&RSB<br>transversus abdominis plane block combined with rectus sheath block | Procedure: erector spinae plane block<br>* The experimental group received ultrasound-guided erector spinae plane block, and bilateral erector spinae plane block was performed at T7 segment with 20ml 0.375% ropivacaine on each side.While the control group received ultrasound-guided transversus abdominis plane block combined with rectus sheath block, which will be performed under the costal margin with 10ml 0.375% ropivacaine for bilateral transversus abdominis plane block and 10ml 0.375% ropivacaine for bilateral rectus sheath block.<br>* Other names: transversus abdominis plane block combined with rectus sheath block;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The dose of morphine used | dosage of analgesic pump | 24 hours after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The dose of morphine used | dosage of analgesic pump | 1hour, 2hours, 4hours and 8hours after surgery | 
| The number of rescue analgesia | times of rescue analgesia | 1hour, 2hours, 4hours, 8hours and 24hours after surgery | 
| Visual analogue scale scores in resting and coughing state | Visual analogue scale (VAS): a 100 mm transverse line with 0mm at one end of the line indicates no pain, 100mm at the other end indicates severe pain and the middle part shows different levels of pain. | 1hour, 2hours, 4hours, 8hours and 24hours after surgery | 
| The value of central venous pressure | ultrasound-guided internal jugular vein catheterization connected with transducer | 5min, 10min, 15min and 30min after nerve block | 
| QoR-15 scores | The QOR-15 scale was scored from 0 (very poor QoR) to 150 (excellent QoR). A higher score indicates a better patient status. | before and 24h after surgery | 
| Quantitative assessment of liver function | The levels of plasma liver function markers AST and ALT before and after liver resection. | before and 1days, 3days after surgery | 
| Postoperative Complications | Including nausea, vomiting, pruritus, dizziness, headache, constipation, urinary retention, respiratory depression and so on. | 2hours, 4hours, 8hours and 24hours after surgery | 
| Recovery time nodes | drainage tube removal time, offbed activity, or postoperative hospital stay, etc. | follow up patients for an average of half a month |