The Safety and Efficacy of Ultrasound-Guided Bilateral Dual Transversus Abdominis Plane (BD-TAP) Block in ERAS Program of Laparoscopic Hepatectomy: A Prospective, Randomized, Controlled, Blinded, Clinical Study

Abstract

Purpose

Postoperative pain management for patients undergoing hepatic resection is still a challenge due to the risk of perioperative liver dysfunction. The transversus abdominis plane (TAP) block is a promising regional analgesic technique. However, the correct guidelines regarding the dose and regimen of local anesthetics in patients undergoing hepatic resection have yet to be established completely. This study aimed to evaluate the safety and efficacy of ultrasound-guided BD-TAP block with a large dose of ropivacaine in laparoscopic hepatectomy.

Patients and Methods

This prospective, blinded, randomized, controlled study was conducted with 50 patients who were scheduled for selective laparoscopic hepatectomy. Patients who received a BD-TAP block (3 mg/kg of ropivacaine diluted to 60 mL) with general anesthesia were categorized into the BD-TAP block group (n = 25), and those who received general anesthesia were categorized into the control group (n = 25). The primary outcomes were consumption of sufentanil within 48 hours post-operation and plasma ropivacaine concentration. The secondary outcomes were the severity of pain (at rest and upon coughing), nausea and/or vomiting, and quality of recovery.

Results

Compared with the control group, the patients in BD-TAP block group had a significant reduction of postoperative sufentanil consumption at 2 hours (P = 0.019), 24 hours (P = 0.001), and 48 hours (P = 0.001), and the visual analog scale (VAS) scores on coughing were significantly lower at postoperative 2 hours (P = 0.004). There were no statistically significant differences in postoperative nausea and/or vomiting, flatus, catheter removal, off-bed activity, liver function, or postoperative hospital stay. The mean peak total ropivacaine concentration was 1,067.85 ng/mL, which occurred 1 hour after administering the block, and mean free ropivacaine concentration was 52.32 ng/mL. The highest individual peak plasma concentration was 2,360.90 ng/mL at 45 min postinjection, and the free ropivacaine concentration was 139.29 ng/mL.

Conclusion

Ultrasound-guided BD-TAP block provides effective postoperative analgesia after laparoscopic hepatectomy. This study also confirms that ultrasound-guided BD-TAP blocks with 3 mg/kg ropivacaine during laparoscopic hepatectomy almost never results in the plasma ropivacaine concentrations associated with neurotoxicity.

Keywords:

• ropivacaine
• laparoscopic hepatectomy
• BD-TAP block
• neurotoxicity

Abbreviations

BD-TAP, bilateral dual transversus abdominis plane; TAP, transversus abdominis plane; VAS, visual analog scale; ERAS, enhanced recovery after surgery; EA, epidural analgesia; CL-TAP, classical TAP; ASA, American Society of Anesthesiologists; PCIA, patient-controlled intravenous analgesia; BMI, body mass index; LC–MS/MS, liquid chromatography–tandem mass spectrometry; SD, standard deviation; PONV, post Operative Nausea And Vomiting; ERCP, endoscopic retrograde cholangiopancreatography; Preop, preoperative; Postop, postoperative; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALB, albumin; TBIL, total bilirubin; DBIL, direct bilirubin; IBIL, indirect bilirubin; CNS, central nervous systems; AAG, Alpha-1 acid glycoprotein.

Data Sharing Statement

The datasets supporting the results of this study are available from the corresponding author.

Ethics and Consent Statement

This study was approved by the Ethics Committee of Sir Run Run Shaw Hospital affiliated with the Zhejiang University School of Medicine. Written informed consent was obtained from all subjects prior to the study. This trial was conducted in accordance with the Declaration of Helsinki.

Disclosure

The authors report no conflicts of interest in this work.