Ultrasound-guided bilateral modified-thoracoabdominal nerve block through a perichondrial approach (M-TAPA) in patients undergoing laparoscopic cholecystectomy: a randomized double-blind controlled trial

Abstract

Background Modified thoracoabdominal nerve block through the perichondrial approach (M-TAPA) is a new technique that provides effective analgesia of the anterior and lateral thoracoabdominal walls by administering local anesthesia only to the underside of the perichondral surface. The primary purpose of the present study was to investigate the postoperative analgesic efficacy of M-TAPA block performed before surgery in patients undergoing laparoscopic cholecystectomy (LC). Method The present study was designed as a double-blind, randomized, controlled, prospective study. A total of 68 patients were included in the study. In group M-TAPA, M-TAPA block was performed bilaterally after the induction of general anesthesia. No block was performed on the group control. The postoperative pain scores, analgesic use in the first 24 h, antiemetic consumption, sedation, postoperative nausea and vomiting (PONV), and Quality of Recovery-40 (QoR-40) scores were recorded. Results Pain scores were significantly lower in group M-TAPA than in the group control, both during resting and motion at all times (p < 0.001 at each time point). The total amount of tramadol consumed in the first 24 h was lower in group M-TAPA [median 100 mg, min-max (0-200)] than in the group control (P < 0.001). Postoperative median QoR-40 scores were higher in group M-TAPA compared with the group control (P < 0.001). There were no differences between the groups in terms of other results. Conclusion After the LC surgery, ultrasound-guided M-TAPA block reduced postoperative pain scores and tramadol consumption effectively. It was observed that the quality of recovery was also higher because QoR-40 scores were higher.

Modified thoracoabdominal nerves block through perichondrial approach for laparoscopic cholecystectomy

“…Gungor et al, compared the M-TAPA block with LA infiltration after LC and reported that, in the M-TAPA group, postoperative pain and the need for rescue analgesia were significantly lower 21 . Bilge et al, showed that the M-TAPA block decreased pain and consumption of tramadol compared with the control group 22 . Erturk et al, compared the TAPA block with the M-TAPA block after LC and showed that NRS scores, tramadol consumption, and rescue analgesic use were similar in the postoperative period 4 .…”

Analgesic efficacy of modified thoracoabdominal nerves block through the perichondrial approach in laparoscopic cholecystectomy: A retrospective study with propensity analysis

“…The multiple‐injection technique and the oblique subcostal TAP block can provide broad‐spectrum analgesia but require multiple punctures or a longer needle 2,12,13 . In contrast, M‐TAPA is advantageous because it provides broad (Th7–11) analgesia with only a single injection of LA 5,8,14–17 …”

“…The ultrasound‐guided procedure avoids penetration of the transversus abdominis muscle and peritoneum. Thus, M‐TAPA is a low‐risk technique and therefore, is an alternative analgesia technique for LC 8,17 …”

“…2,12,13 In contrast, M-TAPA is advantageous because it provides broad (Th7-11) analgesia with only a single injection of LA. 5,8,[14][15][16][17] Another advantage of M-TAPA is its longer analgesic period and safety. The analgesic duration of LAI is only for 2-3 hours, whereas it is approximately 14 hours at M-TAPA.…”

“…Thus, M-TAPA is a low-risk technique and therefore, is an alternative analgesia technique for LC. 8,17 Pre-incisional LA administration was more costeffective, but LA is usually administered at the end of the surgery. 18 It is suggested that LAI and regional nerve blocks may have a preemptive analgesic effect.…”