# The feasibility and effectiveness of one-puncture of rectus sheath block combined with transverse abdominis plane block in patients undergoing thoracoscopic-laparoscopic radical esophagectomy: a prospective randomized controlled study

## TL;DR

This study shows that a one-puncture method for nerve blocks during esophagectomy surgery is faster and more convenient than traditional methods, without reducing pain relief effectiveness.

## Contribution

A novel one-puncture technique for rectus sheath and transverse abdominis plane blocks is introduced and validated for thoracoscopic-laparoscopic esophagectomy.

## Key findings

- The one-puncture method reduced the duration of the nerve block procedure by 16.7 seconds compared to traditional methods.
- The one-puncture method was rated as significantly more convenient than traditional techniques.
- No significant differences in pain scores or adverse effects were observed between the groups.

## Abstract

This study aimed to assess the feasibility and effectiveness of ultrasound-guided one-puncture of rectus sheath block (RSB) combined with the transverse abdominis plane block (TAPB) for patients undergoing thoracoscopic-laparoscopic radical esophagectomy (TLE).

This prospective randomized controlled study enrolled 40 patients aged from 50 to 80 years who were eligible for TLE. The patients were randomly assigned into two groups: intervention group (one-puncture of RSB combined with TAPB) and control group (traditional RSB and TAPB). The primary outcome was the duration of the nerve block procedure, and the secondary endpoints in this study included the convenience of the nerve block operation, sufentanil consumption, visual analog scale (VAS) scores at 2, 4, 6, 12, 24 and 48 h after surgery, the Riker Sedation-Agitation Scale (SAS) score, postoperative nausea and vomiting (PONV), the first time of the need for rescue analgesic, time of first PCIA presses, the duration of the postoperative hospital stay, and the incidence of adverse reactions after surgery.

The duration of the nerve block procedure in the intervention group was significantly shorter than that in the control group (182.7 ± 13.9 s vs. 199.4 ± 10.9 s, p = 0.0003), and the convenience of the nerve block operation in the intervention group was significantly higher than that in the control group (p < 0.001). There were no statistically significant differences between the groups in terms of the RSAS score, VAS scores, total analgesic consumption, additional analgesic use, and adverse effects (p > 0.05).

The one-puncture of RSB combined with TAPB could provide sufficient analgesia for patients undergoing TLE, and reduce the duration of the nerve block procedure and enhance the convenience of the nerve block operation compared to the traditional RSB and TAPB.