Combined Subcostal and Lateral Transversus Abdominis Plane Block for Postoperative Analgesia Versus Thoracic Epidural Analgesia in Patients Undergoing Major Abdominal Cancer Surgery

Safety and Efficacy of Combined Subcostal and Lateral Transversus Abdominis Plane Block for Postoperative Analgesia Versus Thoracic Epidural Analgesia in Patients Undergoing Major Abdominal Cancer Surgery

This study aims to evaluate the safety and efficacy of combined subcostal and lateral transversus abdominis plane (TAP) for postoperative analgesia versus thoracic epidural anesthesia (TEA) in patients undergoing major abdominal cancer surgery.

Postoperative pain is treated using a variety of techniques. It is possible to deliver opioids intravenously, neuraxially, or both.

Thoracic epidural anesthesia (TEA) has long been considered the benchmark for analgesia in major abdominal operations due to its consistent efficacy in pain control and additional benefits such as reduced ileus and improved pulmonary function.

Transversus abdominis plane (TAP) blocks can be a critical component of postoperative pain management, and they play a crucial role in Enhanced Recovery After Surgery (ERAS) protocols, as they significantly affect recovery and patient well-being.

Inclusion Criteria:

• Age ≥ 18 years.
• Both sexes.
• American Society of Anesthesiologists (ASA) physical status I-III.
• Scheduled for major abdominal surgeries including: (e.g., gastrectomy, colectomy, hepatectomy, cystectomy, total abdominal hysterectomy, Nephrectomy, pancreatectomy).

Exclusion Criteria:

• Intraoperative hemodynamic instability.
• History or evidence of coagulopathy.
• Infection or abdominal wall masses at injection site.
• Morbid obesity.
• Other Medical conditions including mental illness or substance abuse.
• Known allergy to local anesthetics.
• Chronic opioid use or chronic pain conditions.
• Pregnancy.