Lingli Cui,1,* Yichen Zhu,2,3,* Shen Liu,1 Liang Zhang,1 Qian Zhu,1 Yun Wang,1 Danxu Ma1 

1Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China; 2Department of Urology, Beijing Friendship hospital, Capital Medical University, Beijing, 100050, People’s Republic of China; 3Institute of Urology, Beijing Municipal Health Commission, Beijing, 100050, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yun Wang, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Beijing, 100050, People’s Republic of China, Email wangyun129@ccmu.edu.cn Danxu Ma, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Beijing, 100050, People’s Republic of China, Email madanxu@126.com

Introduction: Laparoscopic donor nephrectomy (LDN) is the standard procedure for donor nephrectomy for living kidney transplantation. Compared with traditional open surgery, the laparoscopic techniques have been developed to significantly reduce postoperative pain and accelerate postoperative recovery; however, most donors still experience more than moderate pain after surgery. Ensuring maximum perioperative safety and postoperative pain control for donors remains a top priority for LDN. Our group reported a novel blockade technique that allows local anesthetic to be injected directly to reach the low thoracic paravertebral space under direct laparoscopic observation via the arcuate ligament to achieve somatic and visceral pain analgesia; this technique has been successfully applied to patients undergoing retroperitoneal laparoscopic nephrectomy. We hypothesized that compared with the transversus abdominis plane (TAP) block, low thoracic paravertebral block (TPVB) via the arcuate ligament under direct vision would reduce the consumption of postoperative opioids and improve the quality of postoperative recovery of donors after LDN.
Methods/Analysis: This study is a prospective blind, randomized, controlled clinical trial with a concealed al of donors scheduled to undergo elective LDN 1:1 to receive either a low TPVB via the arcuate ligament under direct vision or a TAP block. This study will recruit a total of 82 living kidney donors. The primary outcome is the 15-item recovery quality scale (QoR-15) score at 24 hours after surgery.
Ethics and Dissemination: This trial was approved by the Ethics Committee of Beijing Friendship Hospital, Capital Medical University. This trial study protocol was approved on 30 November 2024. The trial started recruiting patients after being registered on the Chinese Clinical Trial Registry.
Trial Registration Number: ChiCTR2400094612.

Keywords: thoracic paravertebral block, arcuate ligament, laparoscopy, living donor nephrectomy