Ultrasound-Guided Modified Thoracoabdominal Nerve Block Through Perichondrial Approach for Postoperative Analgesia Management in Living Liver Donors: A Randomized, Prospective, Controlled Study

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-09-02 DOI:10.1111/ctr.70224

Hande Gungor, Ayşe Ince, Bahadir Ciftci, Birzat Emre Gölboyu, Mert Asici, Pelin Karaaslan, Tumay Uludag Yanaral

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Abstract

Background

Optimal postoperative pain management in living donor hepatectomy remains challenging, with conventional methods showing limitations. This study evaluated the efficacy and safety of ultrasound-guided modified thoracoabdominal nerve block through a perichondrial approach (M-TAPA) compared to conventional pain management in living donor hepatectomy patients.

Methods

In this prospective, randomized, controlled, single-blind study conducted between April 2024 and January 2025, 50 ASA I-II patients undergoing living donor right hepatectomy were randomly allocated to either the M-TAPA group (n = 25, receiving ultrasound-guided M-TAPA block plus standard analgesia) or the Control group (n = 25, receiving conventional pain management only). The primary outcome was postoperative opioid consumption during the first 48 h. Secondary outcomes included pain scores, rescue analgesia requirements, and complications.

Results

The M-TAPA group showed significantly lower median total fentanyl consumption (p = 0.002) and reduced need for rescue analgesia (p = 0.011) compared to the Control group. Both static and dynamic Numeric Rating Scale pain scores were significantly lower in the M-TAPA group across all time points (p < 0.001). Although the M-TAPA group showed a trend toward reduced nausea incidence (p = 0.066), other side effects were comparable between groups. No M-TAPA block–related complications were reported.

Conclusions

Ultrasound-guided M-TAPA block provides effective postoperative pain management in living donor hepatectomy, demonstrating significant reductions in opioid consumption and pain scores without increasing complications. These findings suggest MTAPA could be a valuable component of enhanced recovery protocols in living donor liver transplantation programs.

Trial Registration

ClinicalTrials.gov identifier: NCT06300372

Abstract Image

查看原文本刊更多论文

超声引导下经软心包入路改良胸腹神经阻滞用于活体肝供者术后镇痛管理：一项随机、前瞻性、对照研究

背景：在活体肝切除术中，最佳的术后疼痛管理仍然具有挑战性，传统方法显示出局限性。本研究评估了超声引导下经软骨膜外入路改良胸腹神经阻滞（M-TAPA）与传统疼痛治疗在活体肝切除术患者中的疗效和安全性。这项前瞻性、随机、对照、单盲研究于2024年4月至2025年1月进行，50例ASA I-II级患者接受活体右肝切除术，随机分为M-TAPA组（n = 25，接受超声引导下的M-TAPA阻滞加标准镇痛）和对照组（n = 25，仅接受常规疼痛管理）。主要结局是术后48小时内阿片类药物的消耗。次要结局包括疼痛评分、抢救镇痛需求和并发症。结果与对照组相比，M-TAPA组芬太尼总用量中位数显著降低（p = 0.002），挽救性镇痛需求显著减少（p = 0.011）。M-TAPA组在所有时间点的静态和动态数值评定量表疼痛评分均显著降低（p < 0.001）。虽然M-TAPA组显示出恶心发生率降低的趋势（p = 0.066），但两组间其他副作用具有可比性。无M-TAPA阻滞相关并发症报道。结论超声引导下M-TAPA阻滞是活体供肝切除术后有效的疼痛管理方法，可显著减少阿片类药物的消耗和疼痛评分，且不会增加并发症。这些发现表明，MTAPA可能是活体供体肝移植项目中增强恢复协议的一个有价值的组成部分。试验注册ClinicalTrials.gov标识符：NCT06300372

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.