Ultrasound-Guided Erector Spinae Plane Block and Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Liver Resection: A Three-Arm Randomized Controlled Trial
In brief
Erector spinae or subcostal TAP block lowers coughing pain by one point
In a trial of 120 patients undergoing laparoscopic liver resection, both erector spinae plane block and subcostal transversus abdominis plane block reduced coughing pain scores by about one point at two hours and cut opioid use, leading to better quality-of-recovery scores on day one. The two techniques performed similarly, so either can be added to multimodal analgesia without a clear superiority.
- Journal
- Journal of pain research (Q1)
- Published
- 11 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Zhengyi Han, Xin Zhou, Tan Xu, Wen Jia, Yangyang Zhang, Zijing Dou, et al.
- PMID
- 42751179
- DOI
- 10.2147/JPR.S623716
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (top studies of the week, 20 September 2026): ESP block vs subcostal TAP block for laparoscopic liver resection
- Picked for Surgery (top studies of the week, 20 September 2026): ESP block and TAP block reduce pain after laparoscopic liver
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.