4. Discussion
visceral pain, TMQLB, somatic pain, toxicity, inferior diaphragmatic fascia, pain
ADVERSE EVENTS, CAVITY
To the best of our knowledge, this study was the first prospective, randomized, controlled study comparing perioperative analgesia and recovery between TMQLB and TPVB in patients undergoing laparoscopic partial nephrectomy. The results demonstrated that the analgesic effect of TMQLB was noninferior to that of TPVB in terms of postoperative 48-hour cumulative morphine consumption. Both groups achieved good postoperative analgesia with similar pain NRS scores at rest and during movement. No significant differences in postoperative recovery data between the two groups were noted.The perioperative pain due to laparoscopic nephrectomy consists of both somatic and visceral elements. The somatic pain caused by gas distention of the abdominal wall, abdominal port placement, and dissection of the abdominal cavity arises from the spinal nerves of T6 to T12. The visceral pain in the renal pelvis is innervated by the sympathetic trunk from T12 to L2 [When injected with the same dosages of ropivacaine, TMQLB produced a wider sensory block range than TPVB. This phenomenon might be explained by the different LA spreading patterns of these two techniques. TMQLB injects LA within a latent fascial space between the PM and QLM. The fascial planes follow the PM and QLM cranially through the medial and lateral arcuate ligaments and the aortic hiatus of the diaphragm, forming the endothoracic fascia and inferior diaphragmatic fascia [Despite a noninferior postoperative 48-hour analgesic effect of TMQLB compared to TPVB based on an For postoperative recovery, the incidences of adverse events, patients' satisfaction with anesthesia scores, and 15-item quality of recovery scores were all similar between the two groups, indicating a comparable safety and recovery profile of both blocks.There are several noteworthy limitations of the current study. First, the ultrasound transducer placement and needle injection sites were different between the TMQLB and TPVB groups; thus, patients might not be fully blinded to the injection methods. However, the chances of identifying different block techniques were low in patients without medical backgrounds. Second, this study did not provide information about differences in pharmacodynamics and risks of systemic toxicity between the two blocks since we did not measure serum LA concentrations. To minimize the risk of toxicity, further studies are needed to determine the minimum dosage of LA that produces the maximum beneficial clinical effects. Third, this study was a single-center study in a specific surgical setting and suffered from all of the shortcomings of this type of study. Since laparoscopic nephrectomy is a moderately invasive surgery with a less invasive wound than open surgery [