Anesth Pain Med.  2024 Oct;19(4):353-361. 10.17085/apm.24086.

Comparison of the effectiveness of subcostal transversus abdominis plane and rectus sheath blocks in postoperative analgesia in major open gynecological cancer surgeries: a prospective randomized study

• Akyol D
• Özcan FG

• KMID: 2563579
• DOI: http://doi.org/10.17085/apm.24086

Abstract

Background
The transversus abdominis plane block (TAPB) is frequently used for postoperative analgesia in abdominal surgery. However, it remains insufficient for analgesia during upper abdominal surgeries. Therefore, we compared the efficacy of the subcostal transversus abdominis plane block (STAPB) or rectus sheath block (RSB), in addition to the posterior transversus abdominis plane block (PTAPB), for postoperative analgesia in major gynecologic cancer surgeries. Methods: This prospective randomized study included 50 patients aged > 18 years (American Society of Anesthesiologists physical status II or III), who underwent gynecologic cancer surgery through a midline incision. All patients underwent PTAPB, STAPB, or RSB according to the randomization. The following parameters were recorded and compared: demographic data; intraoperative hemodynamic parameters; numeric rating scale (NRS) pain levels at the 1st, 6th, 12th, and 24th postoperative hours; opioid consumption; number of requests and boluses; adverse effects; surgical complications within 24 h. Results: Forty-seven patients were included in this study. In the STAPB group, postoperative 1, 12 and 24 h NRS values were lower; opioid consumption, opioid demand, and bolus numbers were lower during the postoperative 24 h as compared to RSB (P < 0.05). The intraoperative opioid and hemodynamic values were similar in both groups. Conclusions: STAPB in addition to PTAPB provides more effective analgesia than RSB for postoperative pain management in open gynecologic cancer surgeries.

Keyword

ERAS; Major gynecologic cancer surgery; Rectus sheath block; Posterior transversus abdominis plan block; Patient controlled analgesia; Subcostal transversus abdominis plane block

Figure

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  Fig. 1. CONSORT of flow diagram of the study. CONSORT: consolidated standards of reporting trials.

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  Fig. 2. Perioperative hemodynamics and NIRS values of each groups. HR: heart rate. MAP: noninvasive blood pressure, SpO2: noninvasive oxygen saturation, NIRS: near-infrared spectroscopy, STAPB: subcostal transversus abdominis plane block, RSB: rectus sheath block. T1: preoperative, T2: end of block, T3: 10 minutes of the block, T4: prostoperative.

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  Fig. 3. Comparison of NIRS values between each group during the first postoperative 24 h. STAPB: subcostal transversus abdominis plane block, RSB: rectus sheath block, NRS: numeric rating scale, NIRS: near-infrared spectroscopy. *P < 0.05.

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  Fig. 4. Morphine demand and delivery numbers with PCA device during the first postoperative 24 h. STAPB: subcostal transversus abdominis plane block, RSB: rectus sheath block, PCA: patient-controlled analgesia. *P < 0.05.

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