# Ultrasound-guided modified thoracoabdominal nerve block for postoperative analgesia in laparoscopic renal cyst decompression: a randomized double-blind controlled trial

## TL;DR

A new ultrasound-guided nerve block reduced post-surgery pain and opioid use in patients undergoing kidney cyst decompression.

## Contribution

Demonstrated the efficacy of modified thoracoabdominal nerve block in laparoscopic renal cyst decompression patients.

## Key findings

- M-TAPA group had significantly lower pain scores at all time points, especially 6 hours post-surgery.
- Opioid consumption was reduced by 22% in the M-TAPA group over 48 hours.
- Fewer antiemetic drugs were needed in the M-TAPA group with no complications observed.

## Abstract

Laparoscopic renal cyst decompression (LRCD) is a common procedure in urology, but postoperative pain remains a significant challenge. While regional nerve blocks provide more targeted pain relief, there is no universally accepted pain management strategy for LRCD. The ultrasound-guided modified thoracoabdominal nerve block (M-TAPA) may offer effective analgesia by blocking the anterior and lateral branches of the intercostal nerves (T5-T12). However, its efficacy in LRCD has not been thoroughly evaluated.

This study aimed to assess the efficacy and safety of unilateral M-TAPA in reducing postoperative pain and opioid consumption in patients undergoing LRCD, and to evaluate its potential benefits in enhancing recovery.

In this randomized, double-blind, controlled trial, 61 patients undergoing LRCD were assigned to either the M-TAPA group (n = 31) or the Control group (n = 30). The M-TAPA group received ultrasound-guided nerve block, while the Control group received a placebo injection. Postoperative pain was assessed using the numerical rating scale (NRS) over a 48-h period. Additional outcomes included opioid consumption and opioid-related side effects, such as nausea and vomiting.

The M-TAPA group had significantly lower NRS scores at all time points compared to the Control group, with the largest difference observed at 6 h postoperatively (4.27 ± 0.83 in the Control group vs. 2.19 ± 0.54 in the M-TAPA group). Repeated measures ANOVA revealed a significant interaction between time and treatment (F = 20.813, p < 0.001). Opioid consumption was reduced by 22% in the M-TAPA group over 48 h (p < 0.001), and the need for antiemetic drugs was significantly lower (p = 0.020). No M-TAPA-related complications were observed.

M-TAPA was found to be an effective method for reducing postoperative pain and opioid consumption in patients undergoing LRCD.

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