Abstract
OBJECTIVE: The analgesic efficacy and safety of transversus abdominis plane block (TAPB) and thoracic paravertebral block (TPVB) were compared following laparoscopic total hysterectomy (LTH), and whether their treatment effects differ by frailty level was also examined. METHODS: From January 2019 to January 2024, an enrolled population of 368 consecutive patients who underwent laparoscopic total hysterectomy was analyzed. Out of 368 patients, 200 patients received TAPB and 168 patients received TPVB. We used propensity score matching to control for baseline confounders, analysed between-group differences in baseline confounders, and in the outcome measure, i.e. 30-day postoperative complication rate. The main outcomes were NRS pain scores and 24-hour sufentanil consumption at 6, 12, and 24 hours post-operatively. Ramsay sedation scores, time to first demand for patient-controlled analgesia (PCA), surgical factors, and adverse events were secondary outcomes. An mFI-5-stratified subgroup interaction analysis was done to evaluate effect robustness across different levels of frailty. RESULTS: PSM yielded 161 matched pairs. Compared to TAPB, TPVB showed significantly lower NRS scores at all postoperative time points (all P<0.001), but higher 24-hour sufentanil consumption (21.50 vs 19.30 μg, P<0.001). Patients in the TPVB group experienced significantly higher incidence of nausea, vomiting, and dizziness. There was no difference in time to first PCA demand (P=0.325). The treatment effects were similar irrespective of frailty level. CONCLUSION: In laparoscopic total hysterectomy, TPVB proved to be more effective than TAPB in controlling postoperative pain, but it required more opioids and was associated with a higher incidence of nausea, vomiting, and dizziness. Safety for all degrees of frailty remained acceptable.