Perioperative analgesic efficacy of ultrasound-guided mid-point transverse process block in patient undergoing laparoscopic radical nephrectomy
Xu Min, Wei Xin, Chai Xiaoqing, Shu Shuhua, Wang Di, Wang Lizhen
Department of Anesthesiology, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei 230001, China
Abstract：Objective To investigate the efficacy and safety of ultrasound-guided mid-point transverse process (MTP) block in the perioperative analgesia of patient undergoing laparoscopic radical nephrectomy. Methods A prospective randomized control trial was conducted. Sixty patients who were scheduled for laparoscopic radical nephrectomy in The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) from November 2019 to December 2020 were included. The patients included 30 males and 30 females aged 32–80 (56.9±9.2) years old and were randomly divided into two groups (MTP group and patient-controlled analgesia [PCA] group). Patients in the MTP group were given general anesthesia combined with ultrasound-guided MTP block. Patients were in the PCA group were only given general anesthesia. Corresponding PCA was linked in both groups after operation. Operative duration, remifentanil dosage, visual analogue scale (VAS) scores at different time (immediately after awake, T1; 4 h after awake, T2; 8 h after awake, T3; 24 h after awake, T4), postoperative remedial analgesia, adverse reaction, and satisfaction score were recorded and compared. Results No significant differences in age, gender, body mass index, and other general information was found in both groups (all P values >0.05). Both groups of patients successfully completed surgery. No complications occurred in MTP group, such as accidental puncture to pleura, blood vessels and nerves. The remifentanil dosage in the MTP group ([1.3±0.2] mg) was lower than that in the PCA group ([1.6±0.2] mg). The effective times of PCA in the MTP group was also lower than that in the PCA group (3.9±1.5 vs 8.2±1.7). Satisfaction score was higher in the MTP group (4.5±1.0) than in the PCA group (3.7±1.6). Statistical differences in remifentanil dosage, effective time, and satisfaction score were found between the two groups (t=4.10, 10.17, 2.22; all P values <0.05). VAS scores at T1 (2.8±0.9) and T2 (2.7±1.0) in the MTP group were lower than those in the PCA group (3.3±1.0 and 3.4±1.0, respectively) with significant differences (t=2.28, 2.88; all P values <0.05). However, VAS score was statistically non-significant at T3 and T4 (all P values >0.05). The total incidence of postoperative adverse reactions in the MTP group was 6.7% (2/30), which was lower than that in the PCA group (30.0% [9/30]) with significant difference (χ2=5.45, P=0.019). Conclusion Ultrasound-guided MTP block is safe and effective and has few complications. It can provide a safe and effective analgesic method for laparoscopic radical nephrectomy by reducing the dosage of opioid analgesics.
张万生, 王立国, 于航, 等. 后腹腔镜肾部分切除术治疗肾肿瘤的疗效及安全性分析[J].中国现代医学杂志, 2017,27(23):87-90. DOI: 10.3969/j.issn.1005-8982.2017.23.018.Zhang WS, Wang LG, Yu H, et al.Efficacy and safety of retroperitoneal laparoscopic partial nephrectomy in treatment of renal tumors[J]. China Journal of Modern Medicine, 2017, 27(23):87-90. DOI: 10.3969/j.issn.1005-8982.2017.23.018.
[2]
吕帅国, 卢锡华, 李长生, 等. 胸椎旁神经阻滞联合全身麻醉用于腹腔镜根治性肾切除术患者的改良效果[J].中华麻醉学杂志, 2020, 40(7):817-820. DOI: 10.3760/cma.j.cn131073.20200413.00712.Lyu GS, Lu XH, Li CS, et al.Modified efficacy of thoracic paravertebral block combined with general anesthesia in patients undergoing laparoscopic radical nephrectomy[J]. Chin J Anesthesiol,2020,40(7):817-820. DOI: 10.3760/cma.j.cn131073.20200413.00712.
[3]
赖洁兰, 薛瑞峰, 康世暘, 等. 术前竖脊肌平面阻滞应用在机器人辅助肾部分切除术的镇痛效果评价[J].中山大学学报(医学科学版),2020,41(5):747-752.Lai JL, Xue RF, Kang SX, et al.Analgesic efficacy of pre-emptive ultrasound-guided erector spinae plane block in robot-assisted partial nephrectomy[J]. Journal of Sun Yat Sen University (Medical Sciences), 2020, 41(5):747-752.
[4]
Forero M, Adhikary SD, Lopez H, et al.The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain[J]. Reg Anesth Pain Med, 2016, 41(5): 621-627. DOI: 10.1097/AAP.0000000000000451.
[5]
喻乐, 吕磊, 徐林, 等. 超声引导腰方肌阻滞对腹腔镜肾切除术后镇痛效果的影响[J].实用医学杂志,2019,35(10):1648-1651. DOI: 10.3969/j.issn.1006-5725.2019.10.026.Yu L, Lyu L, Xu L, et al.Postoperative analgesic effect of ultrasound-guided quadratus lumborum block after laparoscopic nephrec-tomy[J]. Journal of Practical Medicine, 2019, 35(10):1648-1651. DOI: 10.3969/j.issn.1006-5725.2019.10.026.
[6]
Costache I, de Neumann L, Ramnanan CJ, et al. The mid-point transverse process to pleura (MTP) block: a new end-point for thoracic paravertebral block[J]. Anaesthesia, 2017, 72(10):1230-1236. DOI: 10.1111/anae.14004.
[7]
Costache I.Mid-point transverse process to pleura block for surgical anaesthesia[J]. Anaesth Rep, 2019, 7(1): 1-3. DOI: 10.1002/anr3.12003.
[8]
Syal R, Kumar R, Kamal M, et al.Novel block and new indication: ultrasound-guided continuous "mid-point transverse process to pleura" block in a patient with multiple rib fractures[J]. Saudi J Anaesth, 2019,13(4):365-367. DOI: 10.4103/sja.SJA_773_18.
[9]
Eskin MB, Ceylan A, Özhan MÖ, et al.Ultrasound-guided erector spinae block versus mid-transverse process to pleura block for postoperative analgesia in lumbar spinal surgery[J]. Anaesthesist, 2020,69(10):742-750. DOI: 10.1007/s00101-020-00848-w.
[10]
Yang HM, Choi YJ, Kwon HJ, et al.Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study[J]. Anaesthesia, 2018,73(10):1244-1250. DOI: 10.1111/anae.14408.
[11]
Adhikary SD, Bernard S, Lopez H, et al.Erector spinae plane block versus retrolaminar block: a magnetic resonance imaging and anatomical study[J]. Reg Anesth Pain Med, 2018,43(7):756-762. DOI: 10.1097/AAP.0000000000000798.
[12]
Ohgoshi Y, Ikeda T, Kurahashi K.Continuous erector spinae plane block provides effective perioperative analgesia for breast reconstruction using tissue expanders: a report of two cases[J]. J Clin Anesth, 2018,44:1-2. DOI: 10.1016/j.jclinane.2017.10.007.
[13]
Scimia P, Basso Ricci E, Droghetti A, et al.The ultrasound-guided continuous erector spinae plane block for postoperative analgesia in video-assisted thoracoscopic lobectomy[J]. Reg Anesth Pain Med, 2017,42(4):537. DOI: 10.1097/AAP.0000000000000616.
[14]
Chin KJ, Adhikary S, Sarwani N, et al.The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair[J]. Anaesthesia, 2017,72(4):452-460. DOI: 10.1111/anae.13814.
[15]
Ahiskalioglu A, Alici HA, Ari MA.Ultrasound guided low thoracic erector spinae plane block for management of acute herpes zoster[J]. J Clin Anesth, 2018,45:60-61. DOI: 10.1016/j.jclinane.2017.12.018.
[16]
Exadaktylos AK, Buggy DJ, Moriarty DC, et al.Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis?[J]. Anesthesiology, 2006, 105(4):660-664. DOI: 10.1097/00000542-200610000-00008.
2022, Vol. 27 
