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Randomized Controlled Trial
. 2022 Oct 28;22(1):329.
doi: 10.1186/s12871-022-01866-4.

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

Ayşegül Bilge  1   2   3 , Betül Başaran  4   5 , Tayfun Et  4   5 , Muhammet Korkusuz  5 , Rafet Yarımoğlu  5 , Hatice Toprak  4   5 , Nuh Kumru  5
Affiliations
Randomized Controlled Trial

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

Ayşegül Bilge et al. BMC Anesthesiol. .

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.

Keywords: Analgesia; Laparoscopic cholecystectomy; Nerve block; Pain management; Postoperative pain; Ultrasonography.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT diagram of the study
Fig. 2
Fig. 2
Ultrasonographic view of process (A) Ultrasonographic view of the abdominal muscles (B) Ultrasound image of the perichondral area before blocking (C) Sonographic view of the block needle and injection point at the lower aspect of chondrium. Cc: costal cartilage, EO: external oblique muscle, IO: internal oblique muscle, TO: transversus abdominis muscle, LA: local anesthetic
Fig. 3
Fig. 3
NRS change between the 15th minute and 24 h at rest and movement (A) Average NRS scores at rest, for Group M-TAPA and Group Control at various time points of follow-up. (B) Average NRS scores at motion, for Group M-TAPA and Group Control at various time points of follow-up. M-TAPA: modified-thoracoabdominal nerves block through a perichondrial approach, NRS: numerical rating scale
See this image and copyright information in PMC

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