Ultrasound-guided modified thoracoabdominal nerve block for postoperative analgesia in laparoscopic renal cyst decompression: a randomized double-blind controlled trial.

IF 3.1 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Frontiers in Medicine Pub Date : 2025-07-04 eCollection Date: 2025-01-01 DOI:10.3389/fmed.2025.1582428

Mengning Wan, Jun Dong, Ke Wei, Juying Jin, Jun Cao, Baohong Yuan

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引用次数: 0

Abstract

Background: Laparoscopic renal cyst decompression (LRCD) is a common procedure in urology, but postoperative pain remains a significant challenge. While regional nerve blocks provide more targeted pain relief, there is no universally accepted pain management strategy for LRCD. The ultrasound-guided modified thoracoabdominal nerve block (M-TAPA) may offer effective analgesia by blocking the anterior and lateral branches of the intercostal nerves (T5-T12). However, its efficacy in LRCD has not been thoroughly evaluated.

Objective: This study aimed to assess the efficacy and safety of unilateral M-TAPA in reducing postoperative pain and opioid consumption in patients undergoing LRCD, and to evaluate its potential benefits in enhancing recovery.

Methods: In this randomized, double-blind, controlled trial, 61 patients undergoing LRCD were assigned to either the M-TAPA group (n = 31) or the Control group (n = 30). The M-TAPA group received ultrasound-guided nerve block, while the Control group received a placebo injection. Postoperative pain was assessed using the numerical rating scale (NRS) over a 48-h period. Additional outcomes included opioid consumption and opioid-related side effects, such as nausea and vomiting.

Results: The M-TAPA group had significantly lower NRS scores at all time points compared to the Control group, with the largest difference observed at 6 h postoperatively (4.27 ± 0.83 in the Control group vs. 2.19 ± 0.54 in the M-TAPA group). Repeated measures ANOVA revealed a significant interaction between time and treatment (F = 20.813, p < 0.001). Opioid consumption was reduced by 22% in the M-TAPA group over 48 h (p < 0.001), and the need for antiemetic drugs was significantly lower (p = 0.020). No M-TAPA-related complications were observed.

Conclusion: M-TAPA was found to be an effective method for reducing postoperative pain and opioid consumption in patients undergoing LRCD.

Clinical trial registration: www.chictr.org.cn.

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超声引导改良胸腹神经阻滞用于腹腔镜肾囊肿减压术后镇痛的随机双盲对照试验。

背景：腹腔镜肾囊肿减压术（LRCD）是泌尿外科常见的手术，但术后疼痛仍然是一个重大挑战。虽然局部神经阻滞提供了更有针对性的疼痛缓解，但对于LRCD尚无普遍接受的疼痛管理策略。超声引导改良胸腹神经阻滞（M-TAPA）可通过阻滞肋间神经的前支和外侧支（T5-T12）起到有效的镇痛作用。然而，其在LRCD中的疗效尚未得到充分评价。目的：本研究旨在评估单侧M-TAPA在减少LRCD患者术后疼痛和阿片类药物消耗方面的有效性和安全性，并评估其在促进康复方面的潜在益处。方法：在这项随机、双盲、对照试验中，61例LRCD患者被分配到M-TAPA组（n = 31）或对照组（n = 30）。M-TAPA组给予超声引导下的神经阻滞，对照组给予安慰剂注射。术后48小时内采用数值评定量表（NRS）评估疼痛。其他结果包括阿片类药物消耗和阿片类药物相关副作用，如恶心和呕吐。结果：M-TAPA组各时间点NRS评分均显著低于对照组，术后6 h差异最大（对照组4.27 ± 0.83 vs M-TAPA组2.19 ± 0.54）。重复测量方差分析显示时间与治疗之间存在显著的交互作用（F = 20.813,p p p = 0.020）。未见m - tapa相关并发症。结论：M-TAPA是减少LRCD患者术后疼痛和阿片类药物消耗的有效方法。临床试验注册：www.chictr.org.cn。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Medicine Medicine-General Medicine

CiteScore

5.10

自引率

5.10%

发文量

3710

审稿时长

12 weeks

期刊介绍： Frontiers in Medicine publishes rigorously peer-reviewed research linking basic research to clinical practice and patient care, as well as translating scientific advances into new therapies and diagnostic tools. Led by an outstanding Editorial Board of international experts, this multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. In addition to papers that provide a link between basic research and clinical practice, a particular emphasis is given to studies that are directly relevant to patient care. In this spirit, the journal publishes the latest research results and medical knowledge that facilitate the translation of scientific advances into new therapies or diagnostic tools. The full listing of the Specialty Sections represented by Frontiers in Medicine is as listed below. As well as the established medical disciplines, Frontiers in Medicine is launching new sections that together will facilitate - the use of patient-reported outcomes under real world conditions - the exploitation of big data and the use of novel information and communication tools in the assessment of new medicines - the scientific bases for guidelines and decisions from regulatory authorities - access to medicinal products and medical devices worldwide - addressing the grand health challenges around the world