Gungor Hande, Ince Ayşe, Ciftci Bahadir, Emre Gölboyu Birzat, Asici Mert, Karaaslan Pelin, Yanaral Tumay Uludag
Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey.
Department of Anatomy, Istanbul Medipol University, Istanbul, Turkey.
Clin Transplant. 2025 Sep;39(9):e70224. doi: 10.1111/ctr.70224.
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.
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.
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.
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.
ClinicalTrials.gov identifier: NCT06300372.
活体肝移植术后的最佳疼痛管理仍然具有挑战性，传统方法存在局限性。本研究评估了与活体肝移植患者的传统疼痛管理相比，经软骨膜途径的超声引导下改良胸腹神经阻滞（M-TAPA）的疗效和安全性。
在2024年4月至2025年1月进行的这项前瞻性、随机、对照、单盲研究中，50例接受活体右半肝切除术的ASA I-II级患者被随机分配到M-TAPA组（n = 25，接受超声引导下的M-TAPA阻滞加标准镇痛）或对照组（n = 25，仅接受传统疼痛管理）。主要结局是术后48小时内的阿片类药物消耗量。次要结局包括疼痛评分、补救性镇痛需求和并发症。
与对照组相比，M-TAPA组的芬太尼总消耗量中位数显著更低（p = 0.002），补救性镇痛需求减少（p = 0.011）。在所有时间点，M-TAPA组的静态和动态数字评分量表疼痛评分均显著更低（p < 0.001）。尽管M-TAPA组的恶心发生率有降低趋势（p = 0.066），但两组之间的其他副作用相当。未报告与M-TAPA阻滞相关的并发症。
超声引导下的M-TAPA阻滞为活体肝移植术后提供了有效的疼痛管理，在不增加并发症的情况下，阿片类药物消耗量和疼痛评分显著降低。这些发现表明，M-TAPA可能是活体肝移植项目强化康复方案的一个有价值的组成部分。
ClinicalTrials.gov标识符：NCT06300372。
