Modified thoracoabdominal nerve block with perichondrial approach in laparoscopic cholecystectomy surgery: a prospective, randomized, controlled, double-blind study

Year 2024, Volume: 15 Issue: 4, 569 - 578, 31.12.2024

Muhammed Halit Satıcı , Nuray Altay , Betül Kozanhan , Munise Yıldız , Mahmut Sami Tutar , Ersin Turan

https://doi.org/10.18663/tjcl.1571553

Abstract

Aim: Although laparoscopic cholecystectomy (LC) is considered minimally invasive, it can cause moderate to severe pain in the postoperative period. This study investigates the effects of modified thoracoabdominal nerve block with perichondrial approach (M-TAPA) on postoperative analgesia after LC.
Material and Methods: The patients were divided into two groups: Group M (patients who received the M-TAPA block) and Group C (control group patients who did not receive the block). The primary outcome measures were the pain scores at 0, 2, 4, 8, 12, and 24 hours postoperatively. The secondary outcome measures included the total amount of rescue analgesic consumed, the time to first rescue analgesia, the occurrence of complications (nausea, and vomiting), and patient satisfaction.
Results: When the change over time of the numerical rating scale (NRS) scores at 24 hours postoperative was evaluated for both rest and movement, the time*group interaction was statistically significant for NRS scores during both rest and movement (p<0.001 and p<0.001, respectively). The total amount of tramadol consumed within the first 24 hours after surgery was higher in Group C (220 (170-260) vs 70 (0-80); P<0.001). Rescue analgesia was administered to all patien ts in Group C; in Group M, 8 patients did not receive rescue analgesic (p<0.005).
Conclusion: The use of M-TAPA as a component of a multimodal analgesia approach helps to reduce opioid consumption, thereby preventing opioid-related side effects and enhancing postoperative patient comfort.

Keywords

laparoscopic cholecystectomy, m-tapa, multimodal analgesia, numerical rating scale

Ethical Statement

This study was conducted with approval from the Ethics Committee of Harran University Faculty of Medicine (Date: 26 August 2024, Decision: 24.12.01).

Supporting Institution

None

Thanks

None

Laparoskopik kolesistektomi cerrahisinde perikondrial yaklaşımla modifiye torakoabdominal sinir bloğu: prospektif, randomize, kontrollü, çift kör bir çalışma

Abstract

Amaç: Laparoskopik kolesistektomi (LC) minimal invaziv olarak kabul edilmesine rağmen, postoperatif dönemde orta ila şiddetli ağrıya neden olabilir. Bu çalışma, LC sonrası postoperatif analjezi üzerine modifiye torakoabdominal sinir bloğu ile perikondriyal yaklaşımın (M-TAPA) etkilerini araştırmaktadır.
Gereç ve Yöntemler: Hastalar iki gruba ayrıldı: Grup M (M-TAPA bloğu uygulanan hastalar) ve Grup C (blok uygulanmayan kontrol grubu hastalar). Birincil sonuç ölçütleri, postoperatif 0, 2, 4, 8, 12 ve 24 saatlerdeki ağrı skorlarıydı. İkincil sonuç ölçütleri, toplam kurtarıcı analjezik tüketimi, ilk kurtarıcı analjezik ihtiyacına kadar geçen süre, komplikasyonların (bulantı ve kusma) görülmesi ve hasta memnuniyetini içeriyordu.
Bulgular: 24 saatlik postoperatif dönemde hem istirahat hem de hareket halindeki numerik derecelendirme ölçeği (NRS) skorlarının zamana bağlı değişimi değerlendirildiğinde, zaman*grup etkileşimi hem istirahat hem de hareket halindeki NRS skorları için istatistiksel olarak anlamlıydı (p<0.001 ve p<0.001, sırasıyla). Ameliyattan sonraki ilk 24 saatte tüketilen toplam tramadol miktarı Grup C'de daha yüksekti (220 (170-260) vs 70 (0-80); P<0.001). Grup C'deki tüm hastalara kurtarıcı analjezi uygulanırken, Grup M'deki 8 hastaya kurtarıcı analjezik uygulanmadı (p<0.005).
Sonuçlar: Multimodal analjezi yaklaşımının bir bileşeni olarak M-TAPA kullanımı, opioid tüketimini azaltarak opioid kaynaklı yan etkilerin önlenmesine ve postoperatif hasta konforunun artmasına yardımcı olmaktadır.

Keywords

laparoskopik kolesistektomi, m-tapa, multimodal analjezi, numerik derecelendirme ölçeği

Ethical Statement

Bu çalışma Harran Üniversitesi Tıp Fakültesi Etik Komitesi'nin onayıyla yapılmıştır (tarih: 26 Ağustos 2024, Karar: 24.12.01).

Supporting Institution

Yok

Thanks

Yok

References

• Vindal A, Sarda H, Lal P. Laparoscopically guided transversus abdominis plane block offers better pain relief after laparoscopic cholecystectomy: results of a triple blind randomized controlled trial. Surg Endosc. 2021;35(4):1713–21. doi: 10.1007/s00464- 020-07558-9.
• Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative dexamethasone improves Surgical Outcome after laparoscopic cholecystectomy. Ann Surg. 2003;238(5):651–60. doi: 10.1097/01.sla.0000094390.82352.cb.
• Mitra S, Khandelwal P, Roberts K, Kumar S, Vadivelu N. Pain relief in laparoscopic cholecystectomy–a review of the current options. Pain Pract. 2012;12(6):485–96. doi: 10.1111/j.1533- 2500.2011.00513.x.
• Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol. 2009;22(5):588–93. doi: 10.1097/ACO.0b013e328330373a.
• Altıparmak B, Korkmaz TM, Uysal Aİ, Turan M, Gümüş DS. The successful usage of modified thoracoabdominal nerve blocks through perichondrial approach (M-TAPA) for analgesia of laparoscopic ventral hernia repair. J Clin Anesth. 2019;57:1–2. doi: 10.1016/j.jclinane.2019.02.016.
• Jung J, Jung W, Ko EY, et al. Impact of Bilateral Subcostal Plus Lateral Transversus Abdominis Plane Block on Quality of Recovery After Laparoscopic Cholecystectomy: A Randomized Placebo-Controlled Trial. Anesth Analg. 2021;133(6):1624–32. doi: 10.1213/ANE.0000000000005762.
• Tulgar S, Senturk O, Selvi O, et al. Perichondral approach for blockage of thoracoabdominal nerves: Anatomical basis and clinical experience in three cases. J Clin Anesth. 2019;54:8–10. doi: 10.1016/j.jclinane.2018.10.015.
• Tulgar S, Selvi O, Thomas DT, Deveci U, Özer Z. Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides effective analgesia in abdominal surgery and is a choice for opioid-sparing anesthesia. J Clin Anesth. 2019;55:109. doi: 10.1016/j.jclinane.2019.01.003.
• Aikawa K, Tanaka N, Morimoto Y. Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) provides sufficient postoperative analgesia for laparoscopic sleeve gastrectomy. J Clin Anesth. 2020;59:44–45. doi: 10.1016/j. jclinane.2019.06.020.
• Tulgar S, Kapakli MS, Senturk O, Selvi O, Serifsoy TE, Ozer Z. Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial. J Clin Anesth. 2018;49:101-06. doi: 10.1016/j.jclinane.2018.06.019.
• Kapoor T, Wrenn SM, Callas PW, Abu-Jaish W. Cost analysis and supply utilization of LC. Minim Invasive Surg. 2018;10(2018):7838103. doi: 10.1155/2018/7838103.
• Oksar M, Koyuncu O, Turhanoglu S, Temiz M, Oran MC. Transversus abdominis plane block as a component of multimodal analgesia for laparoscopic cholecystectomy. J Clin Anesth. 2016;34:72–8. doi: 10.1016/j.jclinane.2016.03.033.
• Zinboonyahgoon N, Luksanapruksa P, Piyaselakul S, et al. The ultrasound-guided proximal intercostal block: anatomical study and clinical correlation to analgesia for breast surgery. BMC anesthesiology. 2019;19:1-10. doi: 10.1186/s12871-019-0762-2.
• Ciftci B, Alici HA, Ansen G, Sakul BU, Tulgar S. Cadaveric investigation about the spread of thoracoabdominal nerve block through a perichondral approach and modified approach. Korean J Anesthesiol. 2022;75(4):357-59. doi: 10.4097/kja.22137.
• Tanaka N, Suzuka T, Kadoya Y, 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(1):107. doi:10.1186/s12871-022-01652-2.
• Visoiu M, Cassara A, Yang CI. Bilateral Paravertebral Blockade (T7-10) Versus Incisional Local Anesthetic Administration for Pediatric Laparoscopic Cholecystectomy: A Prospective, Randomized Clinical Study. Anesth Analg. 2015;120(5):1106–13. doi: 10.1213/ANE.0000000000000545.
• Taketa Y, Irisawa Y, Fujitani T. Ultrasound-guided erector spinae plane block elicits sensory loss around the lateral, but not the parasternal, portion of the thorax. J Clin Anesth. 2018;47:84–5. doi: 10.1016/j.jclinane.2018.03.023.
• Bilge A, Başaran B, Et T, et al. Ultrasound-guided bilateral modified-thoracoabdominal nerve block through a perichondrial approach (M-TAPA) in patients undergoing laparoscopic cholecystectomy: a randomized double-blind controlled trial. BMC anesthesiology. 2022;22(1):329. doi: 10.1186/s12871-022-01866-4.
• Bilge A, Başaran B, Altıparmak B, Et T, Korkusuz M, Yarımoğlu R. Comparing ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach with oblique subcostal transversus abdominis plane block for patients undergoing laparoscopic cholecystectomy: a randomized, controlled trial. BMC anesthesiology. 2023;23(1):139. doi: 10.1186/s12871-023-02106-z.
• Castillo-Dávila LF, Torres-Anaya CJ, Vazquez-Apodaca R, Borboa-Olivares H, Espino-y-Sosa S, Torres-Torres J. Modified thoracoabdominal nerve block via perichondral approach: an alternative for perioperative pain management in la laparoscopic cholecystectomy in a middle-income country. BMC anesthesiology. 2024;24(1):304. doi: 10.1186/s12871-024-02690-8.
• Erten E, Kara U, Şimşek F, et al. Modified thoracoabdominal nerves block through perichondrial approach for laparoscopic cholecystectomy. Revista da Associação Médica Brasileira. 2024;70(3):e2023. doi: 10.1590/1806-9282.20230962.
• 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. Journal of Anesthesia. 2023;37(2):254-60. doi: 10.1007/ s00540-022-03158-0.
• Saxena R, Joshi S, Srivastava K, Tiwari S, Sharma N, Valecha UK. Comparative study of ultrasound-guided abdominal field blocks versus port infiltration in laparoscopic cholecystectomies for postoperative pain relief. Indian J Anaesth. 2016;60(8):578–83. doi: 10.4103/0019-5049.187790.