Transversus abdominis plane block enhances analgesia and reduces opioid use after laparoscopic donor hepatectomy with intrathecal morphine: a randomized controlled trial

Abstract

Introduction: Intrathecal morphine (ITM) provides effective analgesia for pure laparoscopic donor hepatectomy (PLDH); however, its analgesic effect may be insufficient during the immediate postoperative period. We evaluated whether adding bilateral transversus abdominis plane block (TAPB) to ITM enhances analgesia and recovery in living liver donors undergoing PLDH.

Methods: This randomized controlled trial was conducted at a single center in Korea between 9 May 2023 and 9 October 2024. 80 living liver donors scheduled for PLDH were prospectively randomized into two groups: a control group receiving ITM alone and a TAPB group receiving bilateral TAPB plus ITM. The primary outcome was the worst pain score recorded at rest in the postanesthesia care unit (PACU).

Results: The worst pain score at rest during the PACU stay was significantly lower in the TAPB group than in the control group (median difference: 3; 95% CI 2 to 4; p<0.001). Lower pain scores persisted in the TAPB group for up to 4 hour postoperatively and were accompanied by significantly decreased cumulative opioid consumption at 1, 4 and 24 hours postoperatively (p=0.029, p=0.023, and p=0.018, respectively). At 24 hours postoperatively, the TAPB group reported a higher Quality of Recovery-15K score than the control group (p=0.030). Incidence of opioid-related complications was comparable between groups.

Conclusions: Bilateral TAPB combined with ITM significantly enhanced analgesia and reduced opioid requirements during the immediate postoperative period after PLDH in living liver donors. Additionally, TAPB improved the Quality of Recovery at 24 hours postoperatively.

Trial registration: Clinical research information service identifier: KCT0008406.

Keywords: Acute Pain; Anesthesia, Regional; Nerve Block; Pain, Postoperative.