ArticleClinics (Sao Paulo, Brazil)2026
Preemptive nalbuphine combined with subcostal transversus abdominis plane block for multimodal analgesia in laparoscopic liver resection: a randomized controlled trial of multimodal analgesia for laparoscopic hepatectomy.
Article in Clinics (Sao Paulo, Brazil), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPostoperative pain control is crucial for Laparoscopic Liver Resection (LLR) patients, as poor analgesia may hinder recovery and elevate complication risks.
methods180 LLR patients were randomized into three groups (n = 60 group): Control (C), subcostal TAPB alone (TAPB), and Nalbuphine + subcostal TAPB (N+TAPB). Outcomes included NRS, BCS, Hemodynamics (MAP, HR), PCIA metrics, QoR-15 scores and complications.
resultsAcross the postoperative time points, the NRS scores in Group N+TAPB were significantly lower than those in Group C and Group TAPB (p < 0.05), whereas BCS scores were significantly higher (p < 0.05). At the time points of endotracheal intubation, skin incision, and immediately post-extubation, both MAP and HR in Groups N+TAPB and TAPB were significantly lower than those in Group C (p < 0.05). At 24 h after surgery, the effective number of PCIA compressions and the total dose of rescue non-steroidal anti-inflammatory drugs (parecoxib sodium and/or flurbiprofen axetil, in mg) were significantly lower in Group N+TAPB than in Group C and Group TAPB (p < 0.05). Moreover, the QoR-15 score at 24 h after surgery was highest in Group N+TAPB (p < 0.05). Regarding safety and tolerability, the incidences of nausea, vomiting, and pruritus in Group N+TAPB were significantly lower than those in Group C (p < 0.05).
conclusionThe regimen combining preemptive nalbuphine with subcostal TAPB was associated with better postoperative analgesia, more stable perioperative hemodynamics, and fewer opioid-related adverse events than no regional block and represents a feasible multimodal analgesia strategy for LLR. Because the control group did not receive a sham TAPB, the specific pharmacological contribution of TAPB alone cannot be isolated from a procedural placebo effect.
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