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.

BACKGROUND: Postoperative pain control is crucial for Laparoscopic Liver Resection (LLR) patients, as poor analgesia may hinder recovery and elevate complication risks. METHODS: 180 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. RESULTS: Across 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). CONCLUSION: The 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.