Ultrasound‐Guided Modified Thoracoabdominal Nerve Block Through Perichondrial Approach for Postoperative Analgesia Management in Living Liver Donors: A Randomized, Prospective, Controlled Study

Background Optimal postoperative pain management in living donor hepatectomy remains challenging, with conventional methods showing limitations. This study evaluated the efficacy and safety of ultrasound‐guided modified thoracoabdominal nerve block through a perichondrial approach (M‐TAPA) compared to conventional pain management in living donor hepatectomy patients. Methods In this prospective, randomized, controlled, single‐blind study conducted between April 2024 and January 2025, 50 ASA I‐II patients undergoing living donor right hepatectomy were randomly allocated to either the M‐TAPA group ( n = 25, receiving ultrasound‐guided M‐TAPA block plus standard analgesia) or the Control group ( n = 25, receiving conventional pain management only). The primary outcome was postoperative opioid consumption during the first 48 h. Secondary outcomes included pain scores, rescue analgesia requirements, and complications. Results The M‐TAPA group showed significantly lower median total fentanyl consumption ( p = 0.002) and reduced need for rescue analgesia ( p = 0.011) compared to the Control group. Both static and dynamic Numeric Rating Scale pain scores were significantly lower in the M‐TAPA group across all time points ( p < 0.001). Although the M‐TAPA group showed a trend toward reduced nausea incidence ( p = 0.066), other side effects were comparable between groups. No M‐TAPA block–related complications were reported. Conclusions Ultrasound‐guided M‐TAPA block provides effective postoperative pain management in living donor hepatectomy, demonstrating significant reductions in opioid consumption and pain scores without increasing complications. These findings suggest MTAPA could be a valuable component of enhanced recovery protocols in living donor liver transplantation programs. Trial Registration ClinicalTrials.gov identifier: NCT06300372