Comparison of M-TAPA Block and Intraperitoneal Analgesia in Postoperative Pain Management After Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Abstract

Purpose: Laparoscopic cholecystectomy (LC) is a minimally invasive surgical procedure offering reduced postoperative pain, shorter hospital stays, and faster recovery. Despite these benefits, pain from tissue trauma, pneumoperitoneum, and gallbladder removal remains significant. This study compares the analgesic efficacy of the Modified Thoracoabdominal Nerve Block via Perichondrial Approach (M-TAPA) and intraperitoneal bupivacaine with or without dexmedetomidine in patients undergoing LC. Materials and Methods: This prospective, randomized, single-blind trial included 60 ASA I/II patients undergoing elective LC under general anesthesia. Patients were divided into three groups: M-TAPA block (Group M), intraperitoneal bupivacaine (Group B), and intraperitoneal bupivacaine plus dexmedetomidine (Group BD). Postoperative pain was assessed using the Numeric Rating Scale (NRS) at six-hour intervals for 24 hours. Secondary outcomes included rescue analgesic requirements and side effects. Data were analyzed using ANOVA, Kruskal-Wallis, and Bonferroni post hoc tests. Results: Group BD and Group M showed significantly lower NRS scores compared to Group B (p<0.05), with no statistical difference between Group BD and Group M. None of the patients required rescue analgesics. Bradycardia and hypotension were observed in two patients in Group BD but resolved with atropine. Group M achieved effective analgesia without side effects. Conclusion: M-TAPA block and intraperitoneal bupivacaine with dexmedetomidine provide comparable analgesia after LC. The MTAPA block is a safe and effective alternative with fewer side effects, making it a favorable option for postoperative pain management in LC patients.

Keywords

• acute pain
• nerve block
• regional anesthesia
• ultrasonography

Laparoskopik Kolesistektomi Sonrası Postoperatif Ağrı Yönetiminde M-TAPA Bloğu ile İntraperitoneal Analjezinin Karşılaştırılması: Randomize Kontrollü Bir Çalışma

Abstract

Amaç: Laparoskopik kolesistektomi (LK), postoperatif ağrının azalması, daha kısa hastanede kalış süresi ve hızlı iyileşme gibi avantajlar sunan minimal invaziv bir cerrahi girişimdir. Ancak bu avantajlara rağmen, doku travması, pnömoperiton ve safra kesesinin çıkarılmasına bağlı ağrı önemli bir sorun olmaya devam etmektedir. Bu çalışma, LK uygulanan hastalarda Modifiye Torakoabdominal Sinir Bloğu – Perikondrial Yaklaşım (M-TAPA) ile deksmedetomidinli veya deksmedetomidinsiz intraperitoneal bupivakainin analjezik etkinliğini karşılaştırmayı amaçlamaktadır. Araçlar ve Yöntem: Bu prospektif, randomize, tek kör çalışmaya, genel anestezi altında elektif LK uygulanan ASA I/II sınıfından 60 hasta dahil edildi. Hastalar üç gruba ayrıldı: M-TAPA bloğu (Grup M), intraperitoneal bupivakain (Grup B) ve intraperitoneal bupivakain + deksmedetomidin (Grup BD). Postoperatif ağrı, 24 saat boyunca altı saatlik aralıklarla Sayısal Değerlendirme Skalası (NRS) ile değerlendirildi. İkincil sonuç ölçütleri arasında kurtarıcı analjezik ihtiyacı ve yan etkiler yer aldı. Veriler ANOVA, KruskalWallis ve Bonferroni post-hoc testleri ile analiz edildi. Bulgular: Grup BD ve Grup M, Grup B’ye kıyasla anlamlı derecede daha düşük NRS skorlarına sahipti (p<0.05); ancak Grup BD ile Grup M arasında istatistiksel olarak anlamlı fark saptanmadı. Hiçbir hastada kurtarıcı analjezik gereksinimi olmadı. Grup BD’de iki hastada bradikardi ve hipotansiyon gözlendi, bu durum atropin ile düzeldi. Grup M'de yan etki gözlenmeden etkili analjezi sağlandı. Sonuç: LK sonrası M-TAPA bloğu ile deksmedetomidin içeren intraperitoneal bupivakain karşılaştırılabilir düzeyde analjezi sağlamaktadır. M-TAPA bloğu, daha az yan etki ile etkili ve güvenli bir seçenek olarak öne çıkmakta olup, LK hastalarında postoperatif ağrı yönetimi için tercih edilebilir bir yöntemdir.

Keywords

• akut ağrı
• rejyonel anestezi
• sinir bloğu
• ultrasonografi

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