Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Jan 7;25(1):9.
doi: 10.1186/s12871-024-02884-0.

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

Qian Chen  1 , Xinyue Zhou  1   2 , Fang Wang  1 , Yang Zeng  1 , Bin Qian  1   2 , Haiyun Du  3   4
Affiliations
Randomized Controlled Trial

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

Qian Chen et al. BMC Anesthesiol. .

Abstract

Background: Laparoscopic radical gastrectomy has been reported to be associated with substantial 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-two patients who were undergoing laparoscopic radical gastrectomy surgery under general anesthesia were included. These patients were randomized 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 and T9/10 level using ropivacaine (0.3%, 15 mL). Patients in the TAPB group received bilateral subcostal TAPB one injection per side using ropivacaine (0.3%, 30 mL). 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 h.

Results: The study recruited 62 patients (31 in each group) for the analysis. A comparatively less 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 vs 31.2 (4.4) mg, P < 0.001. The ITPB group showed lower intraoperative opioid use, and statistical 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 (median [IQR]): 8.0 [8.0] vs 6.0 [6.0] h, P = 0.009. The patients in the ITPB group exhibited earlier independent movement, lower incidence of postoperative complications and higher levels of satisfaction (P = 0.021).

Conclusion: This study showed that the double-shot bilateral ITPB could reduce opioids consumption and achieve longer and better pain relief. Additionally, it promoted early postoperative activity and improved patient satisfaction.

Trial registration: ChiCTR2300072986. Registered 29 June 2023.

Keywords: Intertransverse process block; Laparoscopic radical gastrectomy; Postoperative pain; Transversus abdominis plane block; Ultrasound-guided.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of Yancheng First People's Hospital (2023-k-089, 17/06/2023). All patients provided signed informed consent forms. The trial registration number was as follows: ChiCTR2300072986, date of registration: 29/06/2023. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Ultrasound images of two groups. A Ultrasound image of the intertransverse process block: T6/7 transverse process; EM: erector spinae muscle; TP: transverse process; LA: local anesthetic. B A spindle-shaped hypoechoic ultrasound image of LA was shown in the transversus abdominis plane. TAM: transversus abdominis muscle; EOM: external oblique muscle; IOM: internal oblique muscle; LA: local anesthetic
Fig. 2
Fig. 2
Flow diagram of subject enrolment and analysis. ITPB, intertransverse process plane block. TAPB, transversus abdominis plane block
Fig. 3
Fig. 3
Comparison of VAS pain scores at rest and during coughing between ITPB and TAPB. This measurement was repeated at 0, 2, 6, 24, 48 h postoperatively. ITPB, intertransverse process block; TAPB, transversus abdominis plane block. VAS, visual analogue score; Values were expressed as mean (standard deviation). *P < 0.05 vs group T
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Yanagimoto Y, Takiguchi S, Miyazaki Y, et al. Comparison of pain management after laparoscopic distal gastrectomy with and without epidural analgesia. Surg Today. 2016;46(2):229–34. - PubMed
    1. Lao WL, Song QL, Jiang ZM, et al. The effect of oxycodone on post-operative pain and inflammatory cytokine release in elderly patients undergoing laparoscopic gastrectomy. Front Med. 2021;8:700025. - PMC - PubMed
    1. You S, Xu F, Wu Y, et al. Effect of noise isolation using noise-cancelling headphones during laparoscopic surgery for postoperative pain reduction: a randomized clinical trial. J Clin Anesth. 2024;92:111286. - PubMed
    1. Kehlet H. Postoperative opioid sparing to hasten recovery: what are the issues?. Anesthesiology. 2005;102(6):1083–5. - PubMed
    1. Shi DW, Zhou XD, Wang FJ, et al. Opioid-sparing effect of multi-point incision-based rectus sheath block in laparoscopic-assisted radical gastrectomy: a randomized clinical trial. J Clin Med. 2023;12(4):1414. - PMC - PubMed

Publication types

LinkOut - more resources