LAUSR

BACKGROUND To evaluate the analgesic efficacy of a four-quadrant transversus abdominis plane (4QTAP) block and a combination of 4QTAP block with needle electrical twitch and intramuscular electrical stimulation (NETOIMS) in patients undergoing cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC). MATERIALS AND METHODS Eighty-one patients who underwent CRS followed by HIPEC were included in this study. Patients were randomly assigned to one of three groups: Group 1 (intravenous patient-controlled analgesia, control group), Group 2 (preoperative 4QTAP block), and Group 3 (preoperative 4QTAP block and postoperative NETOIMS). The primary study endpoint was the pain score assessed by the visual analogue scale (VAS: 0, no pain; 10, worst imaginable pain) on postoperative day (POD) 1. RESULTS The VAS pain score on POD 1 was significantly lower in Group 2 than in Group 1 (6.0±1.7 and 7.6±1.9, P=0.004), whereas that in Group 3 was significantly lower than that in Groups 1 and 2 (P<0.001 and P=0.004, respectively). Opioid consumption and nausea and vomiting incidence during POD 7 were significantly lower in Group 3 than in Groups 1 and 2. Gait speed and peak cough flow on POD 4 and 7, as well as QoR-40 score on POD 4, were significantly higher in Group 3 than in Groups 1 and 2. CONCLUSIONS The combination of a 4QTAP block with NETOIMS provided more effective analgesia than a 4QTAP block alone after CRS followed by HIPEC and enhanced functional restoration and quality of recovery.