Advantages of Ultrasound-Guided Subcostal Transversus Abdominis Plane Block Combined with Rectus Sheath Block in Thoracoscopic-Laparoscopic Esophagectomy
LIU Jie
HOU Yifan
HAN Xuebin
Abstract：Objective To investigate the analgesic efficacy of ultrasound-assisted subcostal transversus abdominis plane block(OTAPB)combined with rectus sheath block(RSB)for postoperative pain management in patients undergoing thoracoscopic-laparoscopic esophagectomy of esophageal cancer(EC).Methods 80 patients scheduled for elective thoracoscopic and laparoscopic esophagectomy at Anyang Cancer Hospital between November 2023 and May 2024 were prospectively randomized into two groups:the TP group(ultrasound-guided thoracic paravertebral block combined with general anesthesia,n=40)and the OR group(ultrasound-guided oblique subcostal transversus abdominis plane block combined with rectus sheath block and general anesthesia,n=40).Both groups underwent nerve block procedures after anesthesia induction,using 40 mL of 0.25%ropivacaine.Postoperatively,patient-controlled intravenous analgesia was provided to all patients.Primary outcomes included:visual analogue scale(VAS)scores at rest and during cough at 2 h,4 h,8 h,12 h,18 h,and 24 h postoperatively;number of PCA presses and rescue analgesia requirements within 24 h;and duration of nerve block procedure.Secondary outcomes included:MAP,HR,and PPI at predefined timepoints,surgical site,duration,intraoperative opioid and vasopressor use,and complications related to nerve block(hematoma,local anesthetic toxicity,infection)within 24 h postoperatively.Results Compared with the TP group,the OR group had significantly fewer PCA presses(P<0.05)and lower rescue analgesia requirements(P<0.05)within 24 h postoperatively.Additionally,the OR group demonstrated lower VAS scores at rest(4 h,8 h,12 h,18 h)and during cough(2 h,4 h,8 h,12 h,18 h)(P<0.05).The duration of the nerve block procedure was also shorter in the OR group(P<0.05).Conclusion Ultrasound-guided OTAPB+RSB is a more convenient technique that effectively manages postoperative abdominal incisional pain in patients undergoing thoracoscopic and laparoscopic esophagectomy,reducing postoperative pain scores.
Keywords：ultrasound guidancesubcostal transversus abdominis plane blockrectus sheath blockthoracic paravertebral blockesophagectomyVAS score
Publication Date：2026-06-25
Online Publishing Date：2026-09-12(First online date of this platform, not the publication date of the document)
Pages：7( 118-124 )