Intertransverse process block versus subcostal transversus abdominis plane block in patients undergoing laparscopic radical gastrectomy: A prospective randomized controlled trial

Abstract Background：Laparoscopic radical gastrectomy has been reported to be associated with severe trauma and pain. This study compared the impact of ultrasound-(US)-guided, bilateral, double-injection intertransverse process block (ITPB) on postoperative analgesia with subcostal transversus abdominis plane block (TAPB) in patients who were undergoing laparoscopic radical gastrectomy. Methods：Sixty-twopatients (43 men and 19 women) aged 55–80 years who were undergoing laparscopic radical gastrectomy surgery under general anesthesia were included. These patients were randomised to either the ITPB group or the TAPB group. Patients in the ITPB group received a double-shot US-guided bilateral ITPB at the thoracic level T6/7, T9/10 level using ropivacaine (0.3%, 15mL). Patients in the TAPB group received bilateral subcostal TAPB using ropivacaine (0.3%, 30mL). All patients used a BIS-guided combined intravenous and inhalation anesthesia. The primary outcome was defined as postoperative morphine-equivalent consumption during the first 24 hours. Results： The study included 62 patients (31 in each group) for the analysis. A comparatively lesser amount of postoperative opioid consumption was observed in the ITPB group compared with the subcostal TAPB group within the first 24 h postoperatively (mean [standard deviation-(SD)] morphine-equivalent dose): 27.8 (5.7) mg vs31.2 (4.4) mg, P < 0.001. The ITPB group showed lower intraoperative opioid use, and significantly lower scores at rest and coughing at 6, 24 h postoperatively. The time to first requiring rescue analgesia was longer in the ITPB group than the subcostal TAPB group (mean [SD]): 13.2 (14.5) vs 6.5 (8.6) h, P = 0.031. The patients in the ITPB group exhibited a lower incidence of postoperative complications, including postoperative nausea and vomiting and relatively higher levels of satisfaction. Conclusion: This study showed that adouble-shot bilateral ITPB could reduce opioids consumption and achieve longer and better pain relief. Additionally, it promoted early postoperative activity and improved patient satisfaction.