ABSTRACT
@#【Objective】To evaluate the efficacy of three different methods of subcostal transversus abdominis plane（TAP）block for patients undergoing open liver carcinoma resection.【Methods】A total of 60 adult patients，undergoing elective open liver carcinoma resection through a“reverse L”incision below the rib bow，were enrolled. The subjects were randomly divided into three groups（20 cases in each），including Group A，B and C，according to the position of local anesthetic injection. All patients underwent ultrasound- guided bilateral subcostal TAP block under local anesthesia. The TAP injection was injected at the middle line of the clavicle in Group A；Two separate injections were at the parasternal line and at the anterior axillary line in Group B；Multiple injections were proformed between the anterior median line and the middle axillary line in Group C. After completion of TAP block，the onset time，duration，blocking extent，hemodynamics and abdominal muscle thickness were evaluated. The operating time of TAP block and incidence of complications were recorded.【Results】The blocking extent of Group B or Group C was greater than that of Group A（P < 0.05），with no significant difference between Group B and Group C. The duration of TAP block in Group B or Group C was longer than that of Group A，while the onset time was not significantly different between the three groups. The mean arterial pressure and heart rate during laparotomy were higher than the base value in Group A，while there were no evident changes in Group B and Group C. The rectus abdominis became thinner after TAP block in all patients，but there was no significant difference in muscle thickness change among the three groups. The operating time of TAP block in the three groups was （8.4±1.9），（13.8±3.1），（23.3±4.2）min，respectively，with significant difference between any two groups（P < 0.05）. None of the patients enrolled showed such complications as local anesthetic poisoning，abdominal wall hematoma，nerve injury， abdominal viscera injury，and puncture point infection.【Conclusion】The outcome of subcostal TAP block for patients undergoing open liver surgery is related to injecting position of anesthetics. Two- point-injection method is superior to one- point-injection method or multiple-point-injection method，for adequate analgesic extent as well as less operating time.