EFFICACY OF MODIFIED THORACOABDOMINAL NERVE BLOCK THROUGH PERICHONDRIAL APPROACH (M-TAPA) FOR POSTOPERATIVE PAIN RELIEF IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY- A RANDOMIZED CONTROLLED TRIAL
Keywords:
Laparoscopic cholecystectomy, Ultrasonography, Postoperative Pain, Nerve block, Modified thoracoabdominal nerve Block through the Perichondrial ApproachAbstract
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ABSTRACT
Background: Modified thoracoabdominal nerve block through the perichondrial approach (M-TAPA) is a novel block. In this block, the local anesthetic (LA) spread is not inhibited by the linea semilunaris, as seen in the case of the transversus abdominis plane block. Limited literature is available about the extent and duration of analgesia to date. Hence, we planned the present study to evaluate the efficacy of M-TAPA in providing postoperative analgesia in laparoscopic cholecystectomy (LC).
Materials & Methods:In this prospective randomized controlled trial, thirty adult patients scheduled for laparoscopic cholecystectomy were randomly allocated to Group M (M-TAPA block) and Group N (no block). The primary objective of the study was to evaluate the efficacy of the M-TAPA block in reducing the analgesic consumption in the initial 24 postoperative hours. Secondary objectives were to assess the effect of the block on pain scores in the first postoperative 24 hours, the time to make the first rescue analgesic request, intraoperative fentanyl consumption, and the number of dermatomes anesthetized.
Results:Thirty patients were analyzed.In Group M, significantly lower pain scores during the initial four postoperative hours, along with a prolongation of the time for first rescue analgesia (308.33 ± 64.69 vs 13.93 ± 4.11 min, p<0.0001),and lower analgesic requirements were recorded. The T8-T10 dermatomes were uniformly blocked in all patients bilaterally for the first 24 hours. A considerable number of patients exhibited both cranial (T6-T7) and caudal (T11-T12) sensory blockade in both anterior and lateral cutaneous branches. Regression of the caudal spread and complete disappearance of the cranial spread were noted at 24 hours.
Conclusion:M-TAPA block provides uniform sensory blockade of both anterior and lateral cutaneous branches in T8-T10 dermatomes. This approach was found to be effective in reducing postoperative analgesic consumption in patients undergoing LC.
References
Mohamed BH, Hamed AD, Nouran Omar ES,Sherif B, Rasmy BE. Postoperative pain management following laparoscopic cholecystectomy - non-opioid approaches: a review. Future Journal of Pharmaceutical Sciences. 2024;10:1.
Jeong HW, Kim CS, Choi KT, Jeong SM, Kim DH, Lee JH. Preoperative versus Postoperative Rectus Sheath Block for Acute Postoperative Pain Relief after Laparoscopic Cholecystectomy: A Randomized Controlled Study. J Clin Med. 2019;8:1018.
Cao L, Yang T, Hou Y, Yong S, Zhou N. Efficacy and Safety of Different Preemptive Analgesia Measures in Pain Management after Laparoscopic Cholecystectomy: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Pain Ther. 2024;13:1471-97.
Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg. 2019;43:659-95.
Tulgar S, Senturk O, Selvi O, Balaban O, Ahiskalioğlu A, Thomas DT, et al. Perichondral approach for blockage of thoracoabdominal nerves: Anatomical basis and clinical experience in three cases. J Clin Anesth. 2019;54:8-10.
Tulgar S, Selvi O, Thomas DT, Deveci U, Özer Z. Modified thoracoabdominal nerves block through the perichondrial approach (M-TAPA) provides effective analgesia in abdominal surgery and is a choice for opioid sparing anesthesia. J Clin Anesth. 2019; 55:109.
Bilge A, Başaran B, Et T, Korkusuz M, Yarımoğlu R, Toprak H, et al. Ultrasound-guided bilateral modified-thoracoabdominal nerve block through the perichondrial approach (M-TAPA) in patients undergoing laparoscopic cholecystectomy: a randomized double-blind controlled trial. BMC Anesthesiol. 2022;22:329.
Altıparmak B, Korkmaz Toker M, Uysal Aİ, Turan M, Gümüş Demirbilek S. The successful usage of modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) for analgesia of laparoscopic ventral hernia repair. J Clin Anesth. 2019;57:1-2.
Aikawa K, Tanaka N, Morimoto Y. Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides a sufficient postoperative analgesia for laparoscopic sleeve gastrectomy. J Clin Anesth. 2020; 59:44–5.
Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135.
Güngör H, Ciftci B, Alver S, Gölboyu BE, Ozdenkaya Y, Tulgar S. Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) vs local infiltration for pain management after laparoscopic cholecystectomy surgery: a randomized study. J Anesth. 2023;37:254-60.
Erten E, Kara U, Şimşek F, Öztaş M, Süzer MA, Kamburoğlu H, et al. Modified thoracoabdominal nerves block through perichondrial approach for laparoscopic cholecystectomy. Rev Assoc Med Bras (1992). 2024;70:e20230962.
Ertürk T, & Ersoy A. Postoperative Analgesic Efficacy of the Thoracoabdominal Nerves Block Through Perichondrial Approach (TAPA) and Modified-TAPA for Laparoscopic Cholecystectomy: A Randomized Controlled Study. Signa Vitae. 2022;18:114-20.
Tanaka N, Suzuka T, Kadoya Y, Okamoto N, Sato M, Kawanishi H, et al. Efficacy of modified thoracoabdominal nerves block through perichondrial approach in open gynecological surgery: a prospective observational pilot study and a cadaveric evaluation. BMC Anesthesiol. 2022;22:107.
Ohgoshi Y, Kawagoe I, Ando A, Ikegami M, Hanai S, Ichimura K. Novel external oblique muscle plane block for blockade of the lateral abdominal wall: a pilot study on volunteers. Can J Anaesth. 2022 ;69:1203-10.
Ciftci B, Alici HA, Ansen G, Sakul BU, Tulgar S. Cadaveric investigation of the spread of the thoracoabdominal nerve block using the perichondral and modified perichondral approaches. Korean J Anesthesiol. 2022; 75:357–9
Hill J, Ashken T, West S, Macfarlane AJR, El-Boghdadly K, Albrecht E, et al. Core outcome set for peripheral regional anesthesia research: a systematic review and Delphi study. Reg Anesth Pain Med. 2022:rapm-2022-103751.
Tekeli AE, Eker E, Bartin MK, Öner MÖ. The efficacy of transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy cases: a retrospective evaluation of 515 patients. J Int Med Res. 2020;48:300060520944058.
Chen Y, Shi K, Xia Y, Zhang X, Papadimos TJ, Xu X, et al. Sensory Assessment and Regression Rate of Bilateral Oblique Subcostal Transversus Abdominis Plane Block in Volunteers. Reg Anesth Pain Med. 2018;43:174-9.
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