A Comparison of Two Fascial Plane Blocks for Abdominal Analgesia in Laparoscopic Cholecystectomy Surgery (M-TAPA vs. External Oblique Intercostal Plane Block): A Prospective Randomized Study

Abstract

Background: Modified thoracoabdominal nerve block through a perichondrial approach (M-TAPA) and external oblique intercostal plane block (EOIB) provide abdominal analgesia by blocking thoracoabdominal nerves. Our aim was to compare the analgesic efficacy of M-TAPA vs. EOIB on the quality of recovery and pain scores in patients who underwent laparoscopic cholecystectomy surgery (LC). Methods: Patients with American Society of Anesthesiologists status I-II, aged between 18 and 65 years, and scheduled for elective LC under general anesthesia were enrolled in the study. The patients were randomized into two groups: Group M-TAPA (n = 30) and Group EOIB (n = 30). The blocks were performed with 40 mL 0.25% bupivacaine in total. The primary outcome of the study was the global quality of recovery score, and the secondary outcomes were the pain scores, rescue analgesic requirement, and adverse effects during the 24-h postoperative period. Results: The global quality of recovery scores at 24 h were similar in both groups. There was a reduction in the median static and dynamic numerical rating scale (NRS) in the first 2 h postoperatively for M-TAPA compared to the EOIB (p < 0.001). The need for rescue analgesia was significantly lower in the M-TAPA group compared to the EOIB group (p < 0.005). Conclusions: Opioid consumption was lower in the M-TAPA group, and the pain scores of the two groups were similar, with the exception of the first 2 h postoperatively. Both the M-TAPA block and EOIB are effective for analgesia following laparoscopic abdominal surgeries.

Keywords: M-TAPA block; external oblique intercostal plane block; laparoscopic surgery; pain management.

Figure 1

Sonographic visualization of M-TAPA. External oblique muscle, internal oblique muscle, transversus abdominis muscle, and tenth costal cartilage are seen. The arrow indicates the needle trajectory. The tip of the arrow is between the internal oblique muscle and transversus abdominis muscle. EOM; External oblique muscle, IOM; Internal oblique muscle, TAM; Transversus abdominis muscle, CC; Costal cartilage.

Figure 2

Sonographic visualization of EOIB. External oblique muscle, intercostal muscles, and the sixth rib are seen. The arrow indicates the needle trajectory. The tip of the arrow is between the external oblique muscle and intercostal muscles. EOM; External oblique muscle.

Figure 3

CONSORT flow diagram of the study.