To compare the analgesic effect and safety of ultrasound-guided transversus abdominis plane block (TAPB) by using three different approaches in open liver cancer resection.

In this prospective study, 90 liver cancer patients who underwent open liver cancer resection in the Fifth People's Hospital of Dongguan from June 2014 to June 2019 were recruited. Among them, 57 patients were male and 33 female, aged 45-70 years old with a median age of 51 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients received ultrasound-guided TAPB under local anesthesia. According to different approach, all patients were divided into the axillary midline approach, subcostal approach and lateral approach groups by random number table method. The effective block rate, onset time and duration of block, visual analogue scale (VAS) score of postoperative pain were observed in three groups. The duration of block and VAS score among three groups were statistically compared by one-way analysis of variance, and the effective block rate was compared by Chi-square test.

In the subcostal approach group, the effective block rates of T6, T7 and T8 segments were 93%(55/60), 100%(60/60) and 100% (60/60), which were the highest among three groups (P<0.05); the duration of block was (10.9±1.3) h, which was with the longest duration among three groups (F=11.348, P<0.05); the VAS scores at postoperative 1, 4 and 8 h were 1.08±0.37, 1.18±0.48 and 1.81±0.27, which were the lowest scores among three groups (F=64.153, 31.477, 3.617, P<0.05). Abdominal wall hematoma occurred in 1 case in the axillary midline approach group and 1 case in the lateral approach group, whereas no TAPB-related complications were noted in the subcostal approach group.

Ultrasound-guided TAPB is safe and effective, and yields high blocking effect in liver cancer resection. The blocking effect of costal approach is significantly better compared with those of axillary midline and lateral approaches.