UC Davis

Background: Laparoscopic liver resection (LLR) is widely performed for the treatment of liver diseases. Effective postoperative pain control is essential, particularly in patients vulnerable to opioid-related complications due to impaired hepatic function. This study compared the analgesic efficacy and recovery outcomes of ultrasound-guided erector spinae plane block (ESPB) and subcostal transversus abdominis plane block (TAPB) in patients undergoing LLR. Methods: In this single-center randomized controlled trial (ChiCTR2300078378), 120 patients scheduled for LLR were randomly allocated to receive ESPB, subcostal TAPB, or standard care (CON). The primary outcomes were postoperative pain scores at rest and during coughing. Secondary outcomes included cumulative opioid consumption, time to first patient-controlled intravenous analgesia (PCIA) activation, rescue analgesia use, and effective PCIA requests. Early recovery outcomes included time to ambulation, first flatus, length of hospital stay, Quality of Recovery-15 (QoR-15) scores, and adverse events. Results: All 120 patients were included in the analysis. Significant time-by-group interactions were observed for postoperative NRS pain scores at rest and during coughing (P=0.004 and P = 0.003). At 2 hours postoperatively, the estimated mean differences in coughing NRS score were -1.03 points (95% CI, -1.60 to -0.45; P < 0.001) for subcostal TAPB versus CON and -1.15 points (95% CI, -1.73 to -0.57; P < 0.001) for ESPB versus CON. The estimated difference between ESPB and subcostal TAPB was -0.13 points (95% CI, -0.70 to 0.45; P = 1.000). Both blocks reduced cumulative opioid consumption, prolonged time to rescue analgesia, and decreased rescue analgesia events and effective PCIA demands. QoR-15 scores at 24 hours were higher in both block groups compared with control, whereas scores at 30 days were similar among groups. No significant between-group differences were observed in the recorded adverse events. Conclusion: In this single-center randomized trial, both subcostal TAPB and ESPB provide effective opioid-sparing analgesia and improve early recovery after LLR. Neither technique demonstrated consistent superiority across postoperative pain trajectories, suggesting that either block can be incorporated into multimodal analgesia strategies for LLR.