Ultrasound-guided Modified Thoracoabdominal Nerve Block for Postoperative Analgesia in Laparoscopic Renal Cyst Decompression: A Randomized Double-blind Controlled Trial

Ultrasound-guided Modified Thoracoabdominal Nerve Block for Postoperative Analgesia in Laparoscopic Renal Cyst Decompression: A Randomized Double-blind Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Ultrasound-guided Modified Thoracoabdominal Nerve Block for Postoperative Analgesia in Laparoscopic Renal Cyst Decompression: A Randomized Double-blind Controlled Trial Mengning Wan, Ke Wei, Jun Dong, Juying Jin, Jun Cao, Baohong Yuan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5322411/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version 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 following general anesthesia. Postoperative pain was assessed using the numerical rating scale (NRS) over a 48-hour 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 hours 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 hours (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. Biological sciences/Neuroscience Health sciences/Medical research Modified thoracoabdominal nerve block Laparoscopic renal cyst decompression Postoperative analgesia Ultrasound Randomized controlled trial Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Laparoscopic renal cyst decompression (LRCD) is a minimally invasive procedure commonly used to treat large renal cysts, but significant postoperative pain is often experienced ( 1 , 2 ). Traditional analgesic methods, such as patient-controlled intravenous analgesia (PCIA) and epidural anesthesia, are associated with higher rates of complications, including urinary retention, nausea, vomiting, and respiratory depression ( 3 , 4 ). These issues can prolong hospital stays, delay recovery, and compromise postoperative safety ( 5 ). As a result, postoperative pain management in LRCD has shifted towards regional nerve blocks, which offer more precise pain relief and fewer complications. LRCD typically involves three incisions: one for the laparoscopic scope, located 2–3 cm above the iliac crest on the mid-axillary line, and two others, one near the costovertebral angle of the 12th rib and the other below the costal margin on the anterior axillary line ( 1 ). These incisions require regional blockade covering the anterior and lateral branches of the intercostal nerves from T8 to T12 ( 6 ). Thoracic paravertebral block (TPVB) has been shown to be an effective nerve block technique for postoperative pain management in nephrectomy patients ( 7 ). However, TPVB is technically challenging and may lead to serious complications such as pneumothorax and spinal anesthesia ( 8 ), while local infiltration anesthesia often fails to provide adequate analgesia. To address these limitations, the modified thoracoabdominal nerve block through the perichondrial approach (M-TAPA) has been introduced as a new regional anesthesia method ( 9 ). M-TAPA, a type of fascial plane block, offers a safer and more effective option in clinical practice. It provides pain relief by blocking the anterior and lateral cutaneous branches of the intercostal nerves from T6 to T12, effectively covering the abdominal wall, including the incisions made during LRCD ( 9 , 10 ). M-TAPA has primarily been used for surgeries involving anterior abdominal wall incisions, such as gastrectomy, gynecological procedures, and cholecystectomy ( 10 – 12 ). Although a recent case report demonstrated that M-TAPA provided adequate analgesia for a child undergoing right nephrectomy ( 13 ), its application in LRCD remains uncertain. The incisions in LRCD are located on the lateral abdominal wall, necessitating the blockade of the intercostal nerves from T8 to T12. While M-TAPA theoretically covers this area by blocking nerves from T6 to T12 ( 14 , 15 ), variations in nerve block distribution and drug spread may result in inconsistent analgesia. Further investigation is warranted to assess the coverage, analgesic efficacy, and safety of M-TAPA for LRCD, given its potential advantages as a fascial plane block with improved safety and effectiveness in clinical settings. This study aims to address these issues through a randomized, double-blind controlled trial designed to evaluate the effectiveness and safety of unilateral M-TAPA in postoperative analgesia following LRCD. By clarifying the role of M-TAPA in postoperative pain management and enhanced recovery, the findings of this study will provide new evidence for optimizing postoperative pain strategies in LRCD. Materials and Methods Trial Design This randomized double-blind controlled trial was conducted in accordance with the Declaration of Helsinki and was approved by the Medical Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (No. 2024-269). The trial was registered prospectively on the Chinese Clinical Trial Registry (www.chictr.org.cn) with the identifier ChiCTR2400085105 on May 31, 2024. Patients undergoing LRCD were randomly assigned to either the M-TAPA group or the Control group. The sample size was calculated using the Power Analysis and Sample Size software, based on an assumed difference in postoperative numeric rating scale (NRS) scores between means (δ) of 1 and a standard deviation (σ) of 0.8, with a significance level (α) of 0.05 and a statistical power of 0.90. This calculation indicated a minimum of 15 participants per group. Written informed consent was obtained from all participants, and all clinical data were anonymized to ensure confidentiality throughout the study. Patients Seventy patients undergoing unilateral LRCD at our hospital between Jun 2024 and October 2024 were recruited for the study. The first patient was enrolled on June 17, 2024. Inclusion criteria required participants to be 18-70 years of age, weigh 45-85 kg, have a body mass index (BMI) of 18-25 kg/m², and be classified as American Society of Anesthesiologists (ASA) physical status I to III (16). Exclusion criteria included peripheral neuropathy, allergies to opioids or local anesthetics, history of substance or chronic opioid use, recent analgesic use (within 24 hours), contraindications to nerve blocks (such as infection or coagulation disorders), or the need for conversion to open surgery. Grouping and Randomization Patients were transferred to the anesthesia preparation room approximately one hour before surgery, and randomization was performed. Group allocation to either the M-TAPA group or the Control group was carried out using a computer-generated random number table, with assignments concealed in sealed envelopes to ensure blinding. The anesthesiologist administered either the M-TAPA block or a sham block with saline injection according to the group assignment. Patients were blinded to their group allocation, and identical dressings were applied to the puncture sites in both groups to maintain blinding. Surgeons and anesthesiologists involved in the procedure were not responsible for data collection or analysis, ensuring the blinding was maintained throughout the study. Anesthesia Intervention After entering the operating room, all patients were continuously monitored for electrocardiography (ECG), peripheral oxygen saturation (SpO 2 ), non-invasive blood pressure, bispectral index (BIS), end-tidal carbon dioxide (PETCO 2 ), and body temperature. General anesthesia was induced in both groups with intravenous midazolam (0.05 mg/kg), propofol (2 mg/kg), cisatracurium (0.2 mg/kg), and sufentanil (0.5 μg/kg). Anesthesia maintenance was achieved with propofol (4–6 mg/kg/h), remifentanil (0.02–0.2 μg/kg/min), and sevoflurane (0.5 minimum alveolar concentration). PETCO 2 was kept between 35–45 mmHg, and core body temperature was maintained within the normal range throughout the procedure. Surgical Procedures All surgeries were performed by three experienced surgeons using a standardized technique. The procedure involved laparoscopy-assisted renal cyst decompression, with pneumoperitoneum pressure maintained at 12 mmHg. Three endoscopic incisions were made: one above the iliac crest on the midaxillary line, one at the 12th rib angle, and another below the rib margin on the anterior axillary line. A drainage tube was placed at the incision above the iliac crest and was removed 24 hours postoperatively. Conversion to open surgery was performed in cases of severe adhesion or significant intraoperative bleeding, as determined by the surgeon. Implementation of M-TAPA M-TAPA was performed following tracheal intubation. The patient was positioned supine, and a 4.0–12.0 MHz linear ultrasound probe was placed along the anterior axillary line on the surgical side to identify the 10th rib. The 10th rib, along with the external oblique muscle (EOM), internal oblique muscle (IOM), transversus abdominis muscle (TAM), and intercostal muscle (ICM), were visualized ( Figure 1-A ). Under ultrasound guidance (Navi; Shenzhen Wisonic Medical Technology Co, Ltd.), an experienced anesthesiologist used an in-plane technique to insert a 21G, 100mm block needle (Echo Plus; Vygon) towards the cephalic end ( Figure 1-B ). Once the needle tip was positioned on the surface of the TAM under the 10th rib , 30 mL of 0.25% ropivacaine was injected into the plane between the ICM and TAM in the M-TAPA group, or 30 mL of normal saline in the Control group ( Figure 1-C ). Before injection, the fascial plane was confirmed with the "hydrodissection" technique to prevent complications such as organ injury or intravascular injection (17). Sensory block was assessed 30 minutes post-injection using a needle puncture test to evaluate the extent of the blockade ( Figure 1-D ). Postoperative Pain Management Postoperative analgesia was initiated following the completion of suturing, with all anesthetic agents discontinued. Patients received PCIA containing 100 μg sufentanil, 5 mg tropisetron, and 93 mL normal saline, with a total volume of 100 mL. The PCIA settings included a background infusion of 2 mL per hour, a bolus dose of 1 mL available upon patient demand, and a lockout interval of 15 minutes. Pain was assessed using the NRS, ranging from 0 (no pain) to 10 (worst pain). A 1 mL bolus dose was administered if the NRS score exceeded 3, and if pain remained uncontrolled, 50 - 100 mg tramadol was given as rescue analgesia. To prevent postoperative nausea and vomiting (PONV), 2 mg tropisetron were administered intravenously if no contraindications were present. Outcome Measurements Sensory blockade in the lateral abdominal wall was assessed 30 minutes after M-TAPA by a researcher not involved in the surgery, using a needle puncture test. Sensory response was rated on a 3-point scale (0 = no pain, 1 = reduced pain, 2 = normal pain), with scores of 0 or 1 considered effective compared to normal shoulder sensation (11). Pain intensity was measured using the NRS at 1, 2, 4, 6, 12, 24, and 48 hours postoperatively, reflecting the expected duration of ropivacaine's effect. Opioid consumption during and after surgery, including sufentanil, remifentanil, and tramadol, was recorded and converted to morphine equivalents. PONV was evaluated using a descriptive scale (0 = none, 1 = mild nausea, 2 = moderate nausea, 3 = single vomiting, 4 = multiple vomiting). Rescue antiemetics were administered as needed for moderate to severe symptoms, and the rate of antiemetic use was recorded. Additionally, time to first ambulation, time to first passage of flatus, and average length of hospital stay (ALOS) were documented. Statistical Analysis The Kolmogorov-Smirnov test was applied to assess the normality of continuous data. Normally distributed data were expressed as mean ± standard deviation and compared using independent t-tests, while non-normally distributed data were presented as median (interquartile range) and analyzed using the Mann-Whitney U test. Categorical variables were reported as numbers (n) and percentages (%) and compared using the Chi-square test or Fisher's exact test, as appropriate. For the analysis of NRS scores over time, repeated measures analysis of variance (ANOVA) was performed to evaluate the interaction between time and treatment. Statistical significance was set at P < 0.05. All analyses were performed using SPSS software (version 26, SPSS Inc., Chicago, IL, USA). Results Out of the 70 patients initially enrolled, 61 were included in the final analysis, with 31 in the M-TAPA group and 30 in the Control group ( Figure 2 ). There were no significant differences between the groups in demographic characteristics, surgical duration, anesthesia time, estimated blood loss, or ASA grading (all P-values > 0.05, Table 1) . Postoperative Pain Assessment The postoperative NRS scores for both the M-TAPA and Control groups over 48 hours are presented in Figure 3 . At all time points, the M-TAPA group demonstrated consistently lower NRS scores compared to the Control group. The highest score in the Control group was recorded at 6 hours postoperatively (4.27 ± 0.83), while the M-TAPA group showed a significantly lower score (2.19 ± 0.54), representing the largest difference between the groups. Repeated measures ANOVA indicated significant changes in NRS scores over time within both groups (F = 24.483, P < 0.001). Between-group comparisons further revealed that the NRS scores in the M-TAPA group were significantly lower than those in the Control group (F = 197.657, P < 0.001). A significant interaction between time and treatment was observed (F = 20.813, P < 0.001), highlighting the strong analgesic effect of M-TAPA on reducing NRS scores compared to the Control group. Analgesic Consumption The Control group required significantly higher intraoperative and postoperative analgesic doses (in morphine equivalents of sufentanil, remifentanil, and tramadol) compared to the M-TAPA group. As shown in Figure 4 , intraoperatively, the use of sufentanil and remifentanil (in morphine equivalents) was reduced by 8.59% in the M-TAPA group ( P < 0.001). Over the 48-hour postoperative period, the total analgesic consumption (in morphine equivalents of sufentanil and tramadol) was reduced by 22% in the M-TAPA group ( P < 0.001). Postoperative Recovery and Analgesic Demand Table 2 outlines the key postoperative outcomes for the M-TAPA and Control groups. Patients in the M-TAPA group reported significantly lower NRS scores and required fewer rescue analgesic interventions compared to the Control group. The M-TAPA group also had a lower rate of antiemetic use. Recovery was faster in the M-TAPA group, as demonstrated by shorter times to first ambulation and first passage of flatus. Additionally, the ALOS was significantly reduced in the M-TAPA group compared to the control group (all P-values < 0.05). Discussion The present study demonstrated that ultrasound-guided M-TAPA is an effective and safe method for providing postoperative analgesia to the unilateral anterior and lateral abdominal walls in patients undergoing LRCD. M-TAPA significantly reduced postoperative pain, as evidenced by lower NRS scores over the 48-hour period. Furthermore, patients in the M-TAPA group showed a decreased need for opioid analgesics and antiemetic medications, indicating not only better pain control but also fewer opioid-related side effects. Early ambulation and gastrointestinal function recovery were also facilitated in the M-TAPA group, contributing to an overall faster postoperative recovery. Importantly, no complications related to the nerve block were observed, highlighting the safety profile of M-TAPA in this surgical setting. Although LRCD is a minimally invasive procedure, significant postoperative pain can still arise from both the unilateral anterior and lateral abdominal walls, presenting a challenge for effective pain management ( 18 ). Multimodal analgesia, combined with peripheral nerve blocks, has become the preferred approach in such cases. This study evaluated the effectiveness of PCIA combined with M-TAPA for postoperative pain relief. M-TAPA, a novel ultrasound-guided regional anesthesia technique, provides comprehensive analgesia and extensive skin segment coverage following laparoscopic abdominal surgery ( 19 ). The local anesthetic administered beneath the 10th rib blocks the anterior and lateral cutaneous branches of the intercostal nerves, possibly by spreading within the space between the rib cartilage and the origin of the transversus abdominis muscle, known as the space between the intrathoracic fascia, diaphragm, and costophrenic recess (SEDIC) ( 20 ). Local anesthetic was injected into this space, bypassing the obstruction of the abdominal muscle line, to reach both the anterior branches of the thoracoabdominal nerve and the lateral cutaneous branches ( 20 , 21 ), resulting in extensive blockade and effective relief of incision pain in the lateral abdominal wall. Previous reports have shown that a single injection of local anesthetic into the intrathoracic fascia below the rib cartilage can achieve multisegmental intercostal nerve block ( 22 ). In this study, the M-TAPA block provided sensory blockade from T6 to T12 in the lateral abdominal wall 30 minutes after injection, as confirmed by a needle puncture test, covering the three incisions used in LRCD surgery. Acute pain following LRCD surgery typically occurs within the first 48 hours. In this study, NRS scores remained low within 48 hours after M-TAPA with 30 mL of 0.25% ropivacaine, suggesting that the prolonged analgesic effect may be related to the volume and concentration of the local anesthetic. Aikawa et al. ( 10 ) reported a case of laparoscopic sleeve gastrectomy managed with M-TAPA, where abdominal sensory blockade (T6-T12) was maintained for 48 hours and disappeared by 56 hours following the administration of 30 mL of 0.25% ropivacaine per side. Bilge et al. ( 12 ) found that M-TAPA effectively reduced postoperative pain scores and opioid consumption in patients undergoing laparoscopic cholecystectomy. Recent case reports have also demonstrated that M-TAPA provided adequate analgesia for a child undergoing right nephrectomy ( 13 ). In the present study, M-TAPA was administered before surgery, and a significant reduction in intraoperative sufentanil consumption was observed during LRCD. Postoperatively, there was a significant decrease in both NRS scores and the need for additional analgesics within 48 hours, indicating that M-TAPA effectively provided pain relief for lateral abdominal wall surgeries. In addition to pain, complications such as PONV caused by systemic intravenous analgesia, including PCIA, are significant factors that can hinder the rapid postoperative recovery of surgical patients. In this study, M-TAPA was associated with a lower number of PCIA presses and reduced use of antiemetic drugs, which contributed to shorter times to first ambulation, first passage of flatus, and a reduced ALOS. This can be attributed to the ability of nerve blockade to inhibit the transmission of pain impulses, prevent central sensitization, and reduce acute postoperative pain ( 23 ). Consequently, opioid use was decreased, promoting faster recovery of gastrointestinal function, reducing the duration of hospital stay, and facilitating a more rapid overall recovery after surgery ( 24 , 25 ). There are several limitations to this study. The sample size was calculated based on the expected impact of M-TAPA on postoperative pain scores to assess its effectiveness in multimodal analgesia. However, the current sample size was insufficient to evaluate less common adverse events, such as abdominal hematoma, vascular injury, or local anesthetic toxicity. Additionally, this study was conducted at a single center, and variations in local anesthetic diffusion among individuals could affect the outcomes. Therefore, further validation of these findings through large-scale, multicenter studies is needed to confirm the broader clinical application of M-TAPA. Conclusion M-TAPA block effectively reduces postoperative pain, shortens hospital stay, and promotes early recovery in patients undergoing LRCD. Declarations Acknowledgments Not applicable. Conflict of Interest Statement The authors have no conflicts of interest to declare. Ethical Approval The study was approved by the Institutional Review Boards of the First Affiliated Hospital of Chongqing Medical University (No. 2024-269). Informed Consent All participating patients provided written informed consent, and all data were rigorously anonymized. Funding None. Data Availability Statement All the original data are provided in tabular form in the supplementary materials. Author Contributions Conception and design: Mengning Wan and Jun Dong Development of methodology: Mengning Wan and Juying Jin Acquisition of data: Juying Jin, Jun Cao, and Baohong Yuan Analysis and interpretation of data: Mengning Wan, Ke Wei, and Baohong Yuan Writing, review, and revision of the manuscript: Mengning Wan, Ke Wei and Jun Dong Study supervision: Ke Wei, Juying Jin, Jun Cao References Porpiglia F, Autorino R, Cicione A, Pagliarulo V, Falsaperla M, Volpe A, et al. Contemporary urologic minilaparoscopy: indications, techniques, and surgical outcomes in a multi-institutional European cohort. J Endourol . (2014) 28(8):951-7. doi:10.1089/end.2014.0134. Chen W, Xu ZB, Xu L, Cang C, Guo JM. Modified Mini-laparoscopic Surgery Optimized the Laparoscopic Decortication of Renal Cyst. Urol J . (2019) 16(6):547-51. doi:10.22037/uj.v0i0.5029. Ren P, Du Y, He G, Jiang D. 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(2017) 125(5):1733-40. doi:10.1213/ane.0000000000002458. Elferink SEM, Bretveld R, Kwast ABG, Asselman M, Essink JGJ, Potters JW, et al. The effect of enhanced recovery after surgery (ERAS) in renal surgery. World J Urol . (2024) 42(1):490. doi:10.1007/s00345-024-05176-x. Tables Table 1. Baseline Characteristics of M-TAPA and Control Groups Baseline characteristics M-TAPA group (n=31) Control group (n=30) P value Age, years 59.13±10.48 56.43±9.38 0.295 a Male, n(%) 18 (58.07) 16 (53.33) 0.710 b BMI, kg/m 2 24.10±2.67 23.63±2.99 0.514 a ASA physical status ≥ III, n(%) 11 (35.48) 9 (30.00) 0.648 b Operation time, min 51.48±8.90 47.37±8.82 0.075 a Anesthesia time, min 70.68±9.88 67.93±7.96 0.238 a Blood loss, mL 55 (45, 100) 100 (80, 100) 0.122 c a for independent sample t-test, b for chi-square test, and c for Mann-Whitney U test Table 2. Postoperative outcome parameters in M-TAPA and Control groups Postoperative outcomes M-TAPA group (n=31) Control group (n=30) P value Average NRS score 1.87±0.28 3.48±0.49 <0.001 a Rescue analgesia frequency 0 (0,0) 2 (0,3) <0.001 c Antiemetic use, n(%) 5 (16.13) 13 (43.33) 0.020 b First ambulation, h 22 (20, 24) 36 (26, 40) <0.001 c First passage of flatus, h 18 (15.5, 22.0) 39 (30, 44) <0.001 c ALOS, days 3 (3, 4) 4 (3, 5) <0.001 c a for independent sample t-test, b for chi-square test, and c for Mann-Whitney U test Additional Declarations No competing interests reported. Supplementary Files RawData.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5322411","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":382367650,"identity":"dbd4d4c4-1573-41a6-83f3-cb2edb45b407","order_by":0,"name":"Mengning Wan","email":"","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Mengning","middleName":"","lastName":"Wan","suffix":""},{"id":382367651,"identity":"80fee5cc-ddf9-44c4-8f6a-65771c275c53","order_by":1,"name":"Ke Wei","email":"","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ke","middleName":"","lastName":"Wei","suffix":""},{"id":382367652,"identity":"65d06c92-79ee-4206-b3f4-774414df78d6","order_by":2,"name":"Jun Dong","email":"data:image/png;base64,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","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Jun","middleName":"","lastName":"Dong","suffix":""},{"id":382367653,"identity":"4961e3f6-e9ee-49c0-b026-221c7ab065cc","order_by":3,"name":"Juying Jin","email":"","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Juying","middleName":"","lastName":"Jin","suffix":""},{"id":382367654,"identity":"23fa1464-a1cf-41af-b1bf-c2f804bec3df","order_by":4,"name":"Jun Cao","email":"","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jun","middleName":"","lastName":"Cao","suffix":""},{"id":382367655,"identity":"c7644a91-a63d-450e-af4a-23209d01534c","order_by":5,"name":"Baohong Yuan","email":"","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Baohong","middleName":"","lastName":"Yuan","suffix":""}],"badges":[],"createdAt":"2024-10-24 03:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5322411/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5322411/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71100275,"identity":"e60e6f59-8600-489d-98d5-5adceb00b187","added_by":"auto","created_at":"2024-12-11 06:41:08","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1191050,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasound-guided M-TAPA via the perichondrial approach. \u003cstrong\u003eA\u003c/strong\u003e: Ultrasound probe placement on the anterior axillary line showing the 10th rib and surrounding structures. \u003cstrong\u003eB\u003c/strong\u003e: Ultrasound-guided nerve block puncture. \u003cstrong\u003eC\u003c/strong\u003e: Injection of local anesthetic solution. \u003cstrong\u003eD\u003c/strong\u003e: Assessment of the nerve block range. PAL: Posterior axillary line; FAL: Front axillary line; CML: Clavicle midline; LC: Iliac crest; Rib: 10th rib; EOM: External oblique muscle; IOM: Internal oblique muscle; TAM: Transversus abdominis muscle; ICM: Intercostal muscle; LA: Local anesthetic.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5322411/v1/d98c279307ca83820dd9a24a.jpg"},{"id":71100279,"identity":"968576c0-34ef-44fb-8b32-c88980466b77","added_by":"auto","created_at":"2024-12-11 06:41:09","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":999231,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart illustrating the patient selection process for the study.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5322411/v1/79233cbfe265bf87cc471a31.jpg"},{"id":71100277,"identity":"c20798bf-f7c9-45e8-ba11-841c28d0ae9b","added_by":"auto","created_at":"2024-12-11 06:41:08","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":821548,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in NRS scores at different time points over 48 hours for the M-TAPA and Control groups\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5322411/v1/f1c62e34259ac9cae21714d9.jpg"},{"id":71100568,"identity":"de469044-e28b-4ebb-bc64-459f9f60bbc9","added_by":"auto","created_at":"2024-12-11 06:49:10","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":680818,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of intraoperative and postoperative analgesic consumption (morphine equivalents) between M-TAPA and Control groups\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5322411/v1/3d276847afb97eb6e0ad31f8.jpg"},{"id":95802315,"identity":"785492ce-ea60-4698-9524-1ba78dffd0fb","added_by":"auto","created_at":"2025-11-13 08:27:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4265745,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5322411/v1/238dba68-964d-4952-bf16-78e7dfdc2889.pdf"},{"id":71100278,"identity":"d518519c-c1d5-4cd6-8123-0502e3061654","added_by":"auto","created_at":"2024-12-11 06:41:08","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":19497,"visible":true,"origin":"","legend":"","description":"","filename":"RawData.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5322411/v1/e8b5d957bb3ac0aa37e8e0eb.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eUltrasound-guided Modified Thoracoabdominal Nerve Block for Postoperative Analgesia in Laparoscopic Renal Cyst Decompression: A Randomized Double-blind Controlled Trial\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLaparoscopic renal cyst decompression (LRCD) is a minimally invasive procedure commonly used to treat large renal cysts, but significant postoperative pain is often experienced (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Traditional analgesic methods, such as patient-controlled intravenous analgesia (PCIA) and epidural anesthesia, are associated with higher rates of complications, including urinary retention, nausea, vomiting, and respiratory depression (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). These issues can prolong hospital stays, delay recovery, and compromise postoperative safety (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). As a result, postoperative pain management in LRCD has shifted towards regional nerve blocks, which offer more precise pain relief and fewer complications.\u003c/p\u003e \u003cp\u003eLRCD typically involves three incisions: one for the laparoscopic scope, located 2\u0026ndash;3 cm above the iliac crest on the mid-axillary line, and two others, one near the costovertebral angle of the 12th rib and the other below the costal margin on the anterior axillary line (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). These incisions require regional blockade covering the anterior and lateral branches of the intercostal nerves from T8 to T12 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Thoracic paravertebral block (TPVB) has been shown to be an effective nerve block technique for postoperative pain management in nephrectomy patients (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). However, TPVB is technically challenging and may lead to serious complications such as pneumothorax and spinal anesthesia (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), while local infiltration anesthesia often fails to provide adequate analgesia.\u003c/p\u003e \u003cp\u003eTo address these limitations, the modified thoracoabdominal nerve block through the perichondrial approach (M-TAPA) has been introduced as a new regional anesthesia method (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). M-TAPA, a type of fascial plane block, offers a safer and more effective option in clinical practice. It provides pain relief by blocking the anterior and lateral cutaneous branches of the intercostal nerves from T6 to T12, effectively covering the abdominal wall, including the incisions made during LRCD (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). M-TAPA has primarily been used for surgeries involving anterior abdominal wall incisions, such as gastrectomy, gynecological procedures, and cholecystectomy (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Although a recent case report demonstrated that M-TAPA provided adequate analgesia for a child undergoing right nephrectomy (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), its application in LRCD remains uncertain. The incisions in LRCD are located on the lateral abdominal wall, necessitating the blockade of the intercostal nerves from T8 to T12. While M-TAPA theoretically covers this area by blocking nerves from T6 to T12 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), variations in nerve block distribution and drug spread may result in inconsistent analgesia. Further investigation is warranted to assess the coverage, analgesic efficacy, and safety of M-TAPA for LRCD, given its potential advantages as a fascial plane block with improved safety and effectiveness in clinical settings.\u003c/p\u003e \u003cp\u003eThis study aims to address these issues through a randomized, double-blind controlled trial designed to evaluate the effectiveness and safety of unilateral M-TAPA in postoperative analgesia following LRCD. By clarifying the role of M-TAPA in postoperative pain management and enhanced recovery, the findings of this study will provide new evidence for optimizing postoperative pain strategies in LRCD.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cem\u003eTrial Design\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis randomized double-blind controlled trial was conducted in accordance with the Declaration of Helsinki and was approved by the Medical Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (No. 2024-269). The trial was registered prospectively on the Chinese Clinical Trial Registry (www.chictr.org.cn) with the identifier ChiCTR2400085105 on May 31, 2024. Patients undergoing LRCD were randomly assigned to either the M-TAPA group or the Control group. The sample size was calculated using the Power Analysis and Sample Size software, based on an assumed difference in postoperative numeric rating scale (NRS) scores between means (\u0026delta;) of 1 and a standard deviation (\u0026sigma;) of 0.8, with a significance level (\u0026alpha;) of 0.05 and a statistical power of 0.90. This calculation indicated a minimum of 15 participants per group. Written informed consent was obtained from all participants, and all clinical data were anonymized to ensure confidentiality throughout the study. \u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePatients\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSeventy patients undergoing unilateral LRCD at our hospital between Jun 2024 and October 2024 were recruited for the study. The first patient was enrolled on June 17, 2024. Inclusion criteria required participants to be 18-70 years of age, weigh 45-85 kg, have a body mass index (BMI) of 18-25 kg/m\u0026sup2;, and be classified as American Society of Anesthesiologists (ASA) physical status I to III (16). Exclusion criteria included peripheral neuropathy, allergies to opioids or local anesthetics, history of substance or chronic opioid use, recent analgesic use (within 24 hours), contraindications to nerve blocks (such as infection or coagulation disorders), or the need for conversion to open surgery. \u003c/p\u003e\n\u003cp\u003e\u003cem\u003eGrouping and \u003c/em\u003e\u003cem\u003eRandomization\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePatients were transferred to the anesthesia preparation room approximately one hour before surgery, and randomization was performed. Group allocation to either the M-TAPA group or the Control group was carried out using a computer-generated random number table, with assignments concealed in sealed envelopes to ensure blinding. The anesthesiologist administered either the M-TAPA block or a sham block with saline injection according to the group assignment. Patients were blinded to their group allocation, and identical dressings were applied to the puncture sites in both groups to maintain blinding. Surgeons and anesthesiologists involved in the procedure were not responsible for data collection or analysis, ensuring the blinding was maintained throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAnesthesia Intervention\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAfter entering the operating room, all patients were continuously monitored for electrocardiography (ECG), peripheral oxygen saturation (SpO\u003csub\u003e2\u003c/sub\u003e), non-invasive blood pressure, bispectral index (BIS), end-tidal carbon dioxide (PETCO\u003csub\u003e2\u003c/sub\u003e), and body temperature. General anesthesia was induced in both groups with intravenous midazolam (0.05 mg/kg), propofol (2 mg/kg), cisatracurium (0.2 mg/kg), and sufentanil (0.5 \u0026mu;g/kg). Anesthesia maintenance was achieved with propofol (4\u0026ndash;6 mg/kg/h), remifentanil (0.02\u0026ndash;0.2 \u0026mu;g/kg/min), and sevoflurane (0.5 minimum alveolar concentration). PETCO\u003csub\u003e2\u003c/sub\u003e was kept between 35\u0026ndash;45 mmHg, and core body temperature was maintained within the normal range throughout the procedure. \u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSurgical Procedures\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll surgeries were performed by three experienced surgeons using a standardized technique. The procedure involved laparoscopy-assisted renal cyst decompression, with pneumoperitoneum pressure maintained at 12 mmHg. Three endoscopic incisions were made: one above the iliac crest on the midaxillary line, one at the 12th rib angle, and another below the rib margin on the anterior axillary line. A drainage tube was placed at the incision above the iliac crest and was removed 24 hours postoperatively. Conversion to open surgery was performed in cases of severe adhesion or significant intraoperative bleeding, as determined by the surgeon. \u003c/p\u003e\n\u003cp\u003e\u003cem\u003eImplementation of M-TAPA\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eM-TAPA was performed following tracheal intubation. The patient was positioned supine, and a 4.0\u0026ndash;12.0 MHz linear ultrasound probe was placed along the anterior axillary line on the surgical side to identify the 10th rib. The 10th rib, along with the external oblique muscle (EOM), internal oblique muscle (IOM), transversus abdominis muscle (TAM), and intercostal muscle (ICM), were visualized (\u003cstrong\u003eFigure 1-A\u003c/strong\u003e). Under ultrasound guidance (Navi; Shenzhen Wisonic Medical Technology Co, Ltd.), an experienced anesthesiologist used an in-plane technique to insert a 21G, 100mm block needle (Echo Plus; Vygon) towards the cephalic end (\u003cstrong\u003eFigure 1-B\u003c/strong\u003e). Once the needle tip was positioned on the surface of the TAM under the 10th rib , 30 mL of 0.25% ropivacaine was injected into the plane between the ICM and TAM in the M-TAPA group, or 30 mL of normal saline in the Control group (\u003cstrong\u003eFigure 1-C\u003c/strong\u003e). Before injection, the fascial plane was confirmed with the \u0026quot;hydrodissection\u0026quot; technique to prevent complications such as organ injury or intravascular injection (17). Sensory block was assessed 30 minutes post-injection using a needle puncture test to evaluate the extent of the blockade (\u003cstrong\u003eFigure 1-D\u003c/strong\u003e).\u003cem\u003e \u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePostoperative Pain Management\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePostoperative analgesia was initiated following the completion of suturing, with all anesthetic agents discontinued. Patients received PCIA containing 100 \u0026mu;g sufentanil, 5 mg tropisetron, and 93 mL normal saline, with a total volume of 100 mL. The PCIA settings included a background infusion of 2 mL per hour, a bolus dose of 1 mL available upon patient demand, and a lockout interval of 15 minutes. Pain was assessed using the NRS, ranging from 0 (no pain) to 10 (worst pain). A 1 mL bolus dose was administered if the NRS score exceeded 3, and if pain remained uncontrolled, 50 - 100 mg tramadol was given as rescue analgesia. To prevent postoperative nausea and vomiting (PONV), 2 mg tropisetron were administered intravenously if no contraindications were present.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOutcome Measurements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSensory blockade in the lateral abdominal wall was assessed 30 minutes after M-TAPA by a researcher not involved in the surgery, using a needle puncture test. Sensory response was rated on a 3-point scale (0 = no pain, 1 = reduced pain, 2 = normal pain), with scores of 0 or 1 considered effective compared to normal shoulder sensation (11). Pain intensity was measured using the NRS at 1, 2, 4, 6, 12, 24, and 48 hours postoperatively, reflecting the expected duration of ropivacaine\u0026apos;s effect. Opioid consumption during and after surgery, including sufentanil, remifentanil, and tramadol, was recorded and converted to morphine equivalents. PONV was evaluated using a descriptive scale (0 = none, 1 = mild nausea, 2 = moderate nausea, 3 = single vomiting, 4 = multiple vomiting). Rescue antiemetics were administered as needed for moderate to severe symptoms, and the rate of antiemetic use was recorded. Additionally, time to first ambulation, time to first passage of flatus, and average length of hospital stay (ALOS) were documented.\u003cem\u003e \u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Kolmogorov-Smirnov test was applied to assess the normality of continuous data. Normally distributed data were expressed as mean \u0026plusmn; standard deviation and compared using independent t-tests, while non-normally distributed data were presented as median (interquartile range) and analyzed using the Mann-Whitney U test. Categorical variables were reported as numbers (n) and percentages (%) and compared using the Chi-square test or Fisher\u0026apos;s exact test, as appropriate. For the analysis of NRS scores over time, repeated measures analysis of variance (ANOVA) was performed to evaluate the interaction between time and treatment. Statistical significance was set at P \u0026lt; 0.05. All analyses were performed using SPSS software (version 26, SPSS Inc., Chicago, IL, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOut of the 70 patients initially enrolled, 61 were included in the final analysis, with 31 in the M-TAPA group and 30 in the Control group (\u003cstrong\u003eFigure 2\u003c/strong\u003e). There were no significant differences between the groups in demographic characteristics, surgical duration, anesthesia time, estimated blood loss, or ASA grading (all P-values \u0026gt; 0.05, \u003cstrong\u003eTable 1)\u003c/strong\u003e. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePostoperative Pain Assessment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe postoperative NRS scores for both the M-TAPA and Control groups over 48 hours are presented in \u003cstrong\u003eFigure 3\u003c/strong\u003e. At all time points, the M-TAPA group demonstrated consistently lower NRS scores compared to the Control group. The highest score in the Control group was recorded at 6 hours postoperatively (4.27 \u0026plusmn; 0.83), while the M-TAPA group showed a significantly lower score (2.19 \u0026plusmn; 0.54), representing the largest difference between the groups. Repeated measures ANOVA indicated significant changes in NRS scores over time within both groups (F = 24.483, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Between-group comparisons further revealed that the NRS scores in the M-TAPA group were significantly lower than those in the Control group (F = 197.657, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). A significant interaction between time and treatment was observed (F = 20.813, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), highlighting the strong analgesic effect of M-TAPA on reducing NRS scores compared to the Control group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAnalgesic Consumption\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Control group required significantly higher intraoperative and postoperative analgesic doses (in morphine equivalents of sufentanil, remifentanil, and tramadol) compared to the M-TAPA group. As shown in \u003cstrong\u003eFigure 4\u003c/strong\u003e, intraoperatively, the use of sufentanil and remifentanil (in morphine equivalents) was reduced by 8.59% in the M-TAPA group (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001). Over the 48-hour postoperative period, the total analgesic consumption (in morphine equivalents of sufentanil and tramadol) was reduced by 22% in the M-TAPA group (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePostoperative Recovery and Analgesic Demand\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003eoutlines the key postoperative outcomes for the M-TAPA and Control groups. Patients in the M-TAPA group reported significantly lower NRS scores and required fewer rescue analgesic interventions compared to the Control group. The M-TAPA group also had a lower rate of antiemetic use. Recovery was faster in the M-TAPA group, as demonstrated by shorter times to first ambulation and first passage of flatus. Additionally, the ALOS was significantly reduced in the M-TAPA group compared to the control group (all P-values \u0026lt; 0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e The present study demonstrated that ultrasound-guided M-TAPA is an effective and safe method for providing postoperative analgesia to the unilateral anterior and lateral abdominal walls in patients undergoing LRCD. M-TAPA significantly reduced postoperative pain, as evidenced by lower NRS scores over the 48-hour period. Furthermore, patients in the M-TAPA group showed a decreased need for opioid analgesics and antiemetic medications, indicating not only better pain control but also fewer opioid-related side effects. Early ambulation and gastrointestinal function recovery were also facilitated in the M-TAPA group, contributing to an overall faster postoperative recovery. Importantly, no complications related to the nerve block were observed, highlighting the safety profile of M-TAPA in this surgical setting.\u003c/p\u003e \u003cp\u003eAlthough LRCD is a minimally invasive procedure, significant postoperative pain can still arise from both the unilateral anterior and lateral abdominal walls, presenting a challenge for effective pain management (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Multimodal analgesia, combined with peripheral nerve blocks, has become the preferred approach in such cases. This study evaluated the effectiveness of PCIA combined with M-TAPA for postoperative pain relief. M-TAPA, a novel ultrasound-guided regional anesthesia technique, provides comprehensive analgesia and extensive skin segment coverage following laparoscopic abdominal surgery (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The local anesthetic administered beneath the 10th rib blocks the anterior and lateral cutaneous branches of the intercostal nerves, possibly by spreading within the space between the rib cartilage and the origin of the transversus abdominis muscle, known as the space between the intrathoracic fascia, diaphragm, and costophrenic recess (SEDIC) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Local anesthetic was injected into this space, bypassing the obstruction of the abdominal muscle line, to reach both the anterior branches of the thoracoabdominal nerve and the lateral cutaneous branches (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), resulting in extensive blockade and effective relief of incision pain in the lateral abdominal wall. Previous reports have shown that a single injection of local anesthetic into the intrathoracic fascia below the rib cartilage can achieve multisegmental intercostal nerve block (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In this study, the M-TAPA block provided sensory blockade from T6 to T12 in the lateral abdominal wall 30 minutes after injection, as confirmed by a needle puncture test, covering the three incisions used in LRCD surgery.\u003c/p\u003e \u003cp\u003eAcute pain following LRCD surgery typically occurs within the first 48 hours. In this study, NRS scores remained low within 48 hours after M-TAPA with 30 mL of 0.25% ropivacaine, suggesting that the prolonged analgesic effect may be related to the volume and concentration of the local anesthetic. Aikawa et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) reported a case of laparoscopic sleeve gastrectomy managed with M-TAPA, where abdominal sensory blockade (T6-T12) was maintained for 48 hours and disappeared by 56 hours following the administration of 30 mL of 0.25% ropivacaine per side. Bilge et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) found that M-TAPA effectively reduced postoperative pain scores and opioid consumption in patients undergoing laparoscopic cholecystectomy. Recent case reports have also demonstrated that M-TAPA provided adequate analgesia for a child undergoing right nephrectomy (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In the present study, M-TAPA was administered before surgery, and a significant reduction in intraoperative sufentanil consumption was observed during LRCD. Postoperatively, there was a significant decrease in both NRS scores and the need for additional analgesics within 48 hours, indicating that M-TAPA effectively provided pain relief for lateral abdominal wall surgeries.\u003c/p\u003e \u003cp\u003eIn addition to pain, complications such as PONV caused by systemic intravenous analgesia, including PCIA, are significant factors that can hinder the rapid postoperative recovery of surgical patients. In this study, M-TAPA was associated with a lower number of PCIA presses and reduced use of antiemetic drugs, which contributed to shorter times to first ambulation, first passage of flatus, and a reduced ALOS. This can be attributed to the ability of nerve blockade to inhibit the transmission of pain impulses, prevent central sensitization, and reduce acute postoperative pain (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Consequently, opioid use was decreased, promoting faster recovery of gastrointestinal function, reducing the duration of hospital stay, and facilitating a more rapid overall recovery after surgery (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere are several limitations to this study. The sample size was calculated based on the expected impact of M-TAPA on postoperative pain scores to assess its effectiveness in multimodal analgesia. However, the current sample size was insufficient to evaluate less common adverse events, such as abdominal hematoma, vascular injury, or local anesthetic toxicity. Additionally, this study was conducted at a single center, and variations in local anesthetic diffusion among individuals could affect the outcomes. Therefore, further validation of these findings through large-scale, multicenter studies is needed to confirm the broader clinical application of M-TAPA.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eM-TAPA block effectively reduces postoperative pain, shortens hospital stay, and promotes early recovery in patients undergoing LRCD.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Boards of\u0026nbsp;the First Affiliated Hospital of Chongqing Medical University (No. 2024-269).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participating patients provided written informed consent, and all data were rigorously anonymized.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the original data are provided in tabular form in the supplementary materials.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception and design:\u0026nbsp;Mengning Wan and Jun Dong\u003c/p\u003e\n\u003cp\u003eDevelopment of methodology:\u0026nbsp;Mengning Wan and Juying Jin\u003c/p\u003e\n\u003cp\u003eAcquisition of data:\u0026nbsp;Juying Jin, Jun Cao, and Baohong Yuan\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnalysis and interpretation of data:\u0026nbsp;Mengning Wan, Ke Wei, and Baohong Yuan\u003c/p\u003e\n\u003cp\u003eWriting, review, and revision of the manuscript:\u0026nbsp;Mengning Wan, Ke Wei and Jun Dong\u003c/p\u003e\n\u003cp\u003eStudy supervision: Ke Wei, Juying Jin, Jun Cao\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePorpiglia F, Autorino R, Cicione A, Pagliarulo V, Falsaperla M, Volpe A, et al. 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Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides a sufficient postoperative analgesia for laparoscopic sleeve gastrectomy. \u003cem\u003eJ Clin Anesth\u003c/em\u003e. (2020) 59:44-5. doi:10.1016/j.jclinane.2019.06.020.\u003c/li\u003e\n\u003cli\u003eTanaka N, Suzuka T, Kadoya Y, Okamoto N, Sato M, Kawanishi H, et al. Efficacy of modified thoracoabdominal nerves block through perichondrial approach in open gynecological surgery: a prospective observational pilot study and a cadaveric evaluation. \u003cem\u003eBMC Anesthesiol\u003c/em\u003e. (2022) 22(1):107. doi:10.1186/s12871-022-01652-2.\u003c/li\u003e\n\u003cli\u003eBilge A, Başaran B, Et T, Korkusuz M, Yarımoğlu R, Toprak H, et al. Ultrasound-guided bilateral modified-thoracoabdominal nerve block through a perichondrial approach (M-TAPA) in patients undergoing laparoscopic cholecystectomy: a randomized double-blind controlled trial. \u003cem\u003eBMC Anesthesiol\u003c/em\u003e. (2022) 22(1):329. doi:10.1186/s12871-022-01866-4.\u003c/li\u003e\n\u003cli\u003eGurbuz H, Ekinci M, Kaciroglu A. Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) for nephrectomy in children. \u003cem\u003ePaediatr Anaesth\u003c/em\u003e. (2024). doi:10.1111/pan.14959.\u003c/li\u003e\n\u003cli\u003eCiftci B, Alici HA, Ansen G, Sakul BU, Tulgar S. Cadaveric investigation of the spread of the thoracoabdominal nerve block using the perichondral and modified perichondral approaches. \u003cem\u003eKorean J Anesthesiol\u003c/em\u003e. (2022) 75(4):357-9. doi:10.4097/kja.22137.\u003c/li\u003e\n\u003cli\u003eSawada A, Kumita S, Nitta A, Ohsaki Y, Yamakage M. Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA): an anatomical study to evaluate the spread of dye after a simulated injection in soft embalmed Thiel cadavers. \u003cem\u003eReg Anesth Pain Med\u003c/em\u003e. (2023) 48(8):403-7. doi:10.1136/rapm-2022-104275.\u003c/li\u003e\n\u003cli\u003eHorvath B, Kloesel B, Todd MM, Cole DJ, Prielipp RC. The Evolution, Current Value, and Future of the American Society of Anesthesiologists Physical Status Classification System. \u003cem\u003eAnesthesiology\u003c/em\u003e. (2021) 135(5):904-19. doi:10.1097/aln.0000000000003947.\u003c/li\u003e\n\u003cli\u003eEr S, Baskan S, Akcay M, Akcay F, Zengin M. Effects of hydrodissection on anesthesia characteristics in ultrasound guided infraclavicular brachial plexus blockade. \u003cem\u003eMedicine (Baltimore)\u003c/em\u003e. (2022) 101(23):e29241. doi:10.1097/md.0000000000029241.\u003c/li\u003e\n\u003cli\u003eHan X, Yuan G, Zhu X, Li T, Li Y, Zhang P, et al. A comparative study of mini- versus standard laparoscopy in the treatment of renal cysts. \u003cem\u003eMinim Invasive Ther Allied Technol\u003c/em\u003e. (2021) 30(3):179-86. doi:10.1080/13645706.2019.1699835.\u003c/li\u003e\n\u003cli\u003e\u0026Ccedil;ift\u0026ccedil;i B, G\u0026uuml;ng\u0026ouml;r H, Alver S, Akın AN, \u0026Ouml;zdenkaya Y, Tulgar S. Clinical Experience for Modified Thoracoabdominal Nerve Block Through Perichondrial Approach (M-TAPA) in Five Patients. Dermatomal Evaluation and Application of Different Volumes: A Case Series and Review of Literature. \u003cem\u003eTurk J Anaesthesiol Reanim\u003c/em\u003e. (2023) 51(4):354-7. doi:10.4274/tjar.2022.221042.\u003c/li\u003e\n\u003cli\u003eOhgoshi Y, Anetai H, Hanai S, Ichimura K, Kawagoe I. The key to success in blocking lateral cutaneous branches with re-modified thoracoabdominal nerves block through perichondrial approach: a newly discovered space between the endothoracic fascia, diaphragm, and costodiaphragmatic recess. \u003cem\u003eJ Anesth\u003c/em\u003e. (2024) 38(5):642-9. doi:10.1007/s00540-024-03366-w.\u003c/li\u003e\n\u003cli\u003eTulgar S, Senturk O, Selvi O, Balaban O, Ahiskalioğlu A, Thomas DT, et al. Perichondral approach for blockage of thoracoabdominal nerves: Anatomical basis and clinical experience in three cases. \u003cem\u003eJ Clin Anesth\u003c/em\u003e. (2019) 54:8-10. doi:10.1016/j.jclinane.2018.10.015.\u003c/li\u003e\n\u003cli\u003eZinboonyahgoon N, Luksanapruksa P, Piyaselakul S, Pangthipampai P, Lohasammakul S, Luansritisakul C, et al. The ultrasound-guided proximal intercostal block: anatomical study and clinical correlation to analgesia for breast surgery. \u003cem\u003eBMC Anesthesiology\u003c/em\u003e. (2019) 19(1):94. doi:10.1186/s12871-019-0762-2.\u003c/li\u003e\n\u003cli\u003eAlm\u0026aacute;si RG. [Ultrasound imaging has a potential to exhibit biotechnical advance in perioperative pain management]. \u003cem\u003eOrv Hetil\u003c/em\u003e. (2019) 160(15):573-84. doi:10.1556/650.2019.31374.\u003c/li\u003e\n\u003cli\u003eHah JM, Bateman BT, Ratliff J, Curtin C, Sun E. Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic. \u003cem\u003eAnesth Analg\u003c/em\u003e. (2017) 125(5):1733-40. doi:10.1213/ane.0000000000002458.\u003c/li\u003e\n\u003cli\u003eElferink SEM, Bretveld R, Kwast ABG, Asselman M, Essink JGJ, Potters JW, et al. The effect of enhanced recovery after surgery (ERAS) in renal surgery. \u003cem\u003eWorld J Urol\u003c/em\u003e. (2024) 42(1):490. doi:10.1007/s00345-024-05176-x.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eBaseline Characteristics of M-TAPA and Control Groups\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.1443%;\"\u003e\n \u003cp\u003eBaseline characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.8041%;\"\u003e\n \u003cp\u003eM-TAPA group (n=31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.7423%;\"\u003e\n \u003cp\u003eControl group (n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3093%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.1443%;\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e59.13\u0026plusmn;10.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.7423%;\"\u003e\n \u003cp\u003e56.43\u0026plusmn;9.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3093%;\"\u003e\n \u003cp\u003e0.295\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.1443%;\"\u003e\n \u003cp\u003eMale, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e18 (58.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.7423%;\"\u003e\n \u003cp\u003e16 (53.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.3093%;\"\u003e\n \u003cp\u003e0.710\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.1443%;\"\u003e\n \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e24.10\u0026plusmn;2.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.7423%;\"\u003e\n \u003cp\u003e23.63\u0026plusmn;2.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3093%;\"\u003e\n \u003cp\u003e0.514\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.1443%;\"\u003e\n \u003cp\u003eASA physical status \u0026ge; III, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e11 (35.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.7423%;\"\u003e\n \u003cp\u003e9 (30.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.3093%;\"\u003e\n \u003cp\u003e0.648\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.1443%;\"\u003e\n \u003cp\u003eOperation time, min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e51.48\u0026plusmn;8.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.7423%;\"\u003e\n \u003cp\u003e47.37\u0026plusmn;8.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3093%;\"\u003e\n \u003cp\u003e0.075\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.1443%;\"\u003e\n \u003cp\u003eAnesthesia time, min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e70.68\u0026plusmn;9.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.7423%;\"\u003e\n \u003cp\u003e67.93\u0026plusmn;7.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3093%;\"\u003e\n \u003cp\u003e0.238\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.1443%;\"\u003e\n \u003cp\u003eBlood loss, mL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e55 (45, 100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.7423%;\"\u003e\n \u003cp\u003e100 (80, 100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3093%;\"\u003e\n \u003cp\u003e0.122\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003efor independent sample t-test, \u003csup\u003eb\u003c/sup\u003efor chi-square test, and \u003csup\u003ec\u003c/sup\u003efor Mann-Whitney U test\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003ePostoperative outcome parameters in M-TAPA and Control groups\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34.9829%;\"\u003e\n \u003cp\u003ePostoperative\u0026nbsp;outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.6212%;\"\u003e\n \u003cp\u003eM-TAPA group (n=31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.5734%;\"\u003e\n \u003cp\u003eControl group (n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8225%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34.9829%;\"\u003e\n \u003cp\u003eAverage NRS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.6212%;\"\u003e\n \u003cp\u003e1.87\u0026plusmn;0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.5734%;\"\u003e\n \u003cp\u003e3.48\u0026plusmn;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8225%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34.9829%;\"\u003e\n \u003cp\u003eRescue analgesia frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.6212%;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.5734%;\"\u003e\n \u003cp\u003e2 (0,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8225%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34.9829%;\"\u003e\n \u003cp\u003eAntiemetic use, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.6212%;\"\u003e\n \u003cp\u003e5 (16.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.5734%;\"\u003e\n \u003cp\u003e13 (43.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8225%;\"\u003e\n \u003cp\u003e0.020\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34.9829%;\"\u003e\n \u003cp\u003eFirst ambulation, h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.6212%;\"\u003e\n \u003cp\u003e22 (20, 24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.5734%;\"\u003e\n \u003cp\u003e36 (26, 40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8225%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34.9829%;\"\u003e\n \u003cp\u003eFirst passage of flatus, h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.6212%;\"\u003e\n \u003cp\u003e18 (15.5, 22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.5734%;\"\u003e\n \u003cp\u003e39 (30, 44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8225%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34.9829%;\"\u003e\n \u003cp\u003eALOS, days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.6212%;\"\u003e\n \u003cp\u003e3 (3, 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.5734%;\"\u003e\n \u003cp\u003e4 (3, 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8225%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003efor independent sample t-test, \u003csup\u003eb\u003c/sup\u003efor chi-square test, and \u003csup\u003ec\u003c/sup\u003efor Mann-Whitney U test\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Modified thoracoabdominal nerve block, Laparoscopic renal cyst decompression, Postoperative analgesia, Ultrasound, Randomized controlled trial","lastPublishedDoi":"10.21203/rs.3.rs-5322411/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5322411/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eLaparoscopic 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.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this randomized, double-blind, controlled trial, 61 patients undergoing LRCD were assigned to either the M-TAPA group (n\u0026thinsp;=\u0026thinsp;31) or the Control group (n\u0026thinsp;=\u0026thinsp;30). The M-TAPA group received ultrasound-guided nerve block, while the Control group received a placebo injection following general anesthesia. Postoperative pain was assessed using the numerical rating scale (NRS) over a 48-hour period. Additional outcomes included opioid consumption and opioid-related side effects, such as nausea and vomiting.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe M-TAPA group had significantly lower NRS scores at all time points compared to the Control group, with the largest difference observed at 6 hours postoperatively (4.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83 in the Control group vs. 2.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54 in the M-TAPA group). Repeated measures ANOVA revealed a significant interaction between time and treatment (F\u0026thinsp;=\u0026thinsp;20.813, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Opioid consumption was reduced by 22% in the M-TAPA group over 48 hours (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the need for antiemetic drugs was significantly lower (P\u0026thinsp;=\u0026thinsp;0.020). No M-TAPA-related complications were observed.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eM-TAPA was found to be an effective method for reducing postoperative pain and opioid consumption in patients undergoing LRCD.\u003c/p\u003e","manuscriptTitle":"Ultrasound-guided Modified Thoracoabdominal Nerve Block for Postoperative Analgesia in Laparoscopic Renal Cyst Decompression: A Randomized Double-blind Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-11 06:41:03","doi":"10.21203/rs.3.rs-5322411/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"451e0d2c-96a4-4575-b06c-0cbf6e0fb60f","owner":[],"postedDate":"December 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":40813768,"name":"Biological sciences/Neuroscience"},{"id":40813769,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-11-12T15:39:07+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-11 06:41:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5322411","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5322411","identity":"rs-5322411","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}