Cholecystectomy is the most frequently performed abdominal surgery in developed nations,with laparoscopic cholecystectomy being recognized as the gold standard technique fortreating gallstones.The efficacy of TAP block for pain relief has been well-documented following laparoscopiccholecystectomy procedures. Recently, m-TAPA block has emerged as an alternativeanalgesic technique for abdominal surgeries.This study aims to evaluate and compare the effectiveness of these two analgesic methodsin managing postoperative pain after laparoscopic cholecystectomy.
Cholecystectomy is the most commonly performed abdominal surgery in developed countries,
with laparoscopic cholecystectomy regarded as the gold standard technique for gallstone
treatment.
Postoperative pain following laparoscopic cholecystectomy is influenced by several
factors, making it a complex and predominantly visceral pain. These factors include
phrenic nerve irritation due to CO2 insufflation, abdominal distension, port site
incisions, the effects of gallbladder removal, and individual patient characteristics.
Regional analgesia has gained widespread acceptance from both patients and physicians,
becoming a key component of multimodal analgesia techniques. The transversus abdominis
plane (TAP) block has proven effective in reducing postoperative pain in surgeries such
as hysterectomy, cholecystectomy, cesarean section, and colorectal procedures.
The Ultrasound (US)-guided Modified Thoracoabdominal Nerve Block Through Perichondrial
Approach (M-TAPA) involves administering a local anesthetic to the underside of the
perichondral surface. This technique provides effective analgesia for the anterior and
lateral thoracoabdominal regions.
The purpose of this study is to compare the efficacy of US-guided M-TAPA block with TAP
block for postoperative analgesia following cholecystectomy.
Other: modified thoracoabdominal nerve block through perichondrial approach
After the patient fell asleep, surgery was not yet started. Following sterile conditions
for bilateral M-TAPA block application, the transducer was inserted on the chondrium in
the sagittal plane at the 9-10th rib level. Subsequently, a deep angle was created with
the probe for visualization of the underside of the costochondrium. The sonovisible
needle tip was placed just below the chondrium and saline (5 ml) was injected for site
confirmation. After the confirmation, 20 ml of 0.25% bupivacaine was administered for
each group for a total of 40 ml of local anesthetic. Blocks were applied using an 80 mm
sonovisible needle with a 6-10 MHz linear probe under the guidance of a portable
ultrasound. Same procedure applied to the contralateral side.
Other: Transversus Abdominal Plane block
After the patient fell asleep, surgery was not yet started. Following sterile conditions
for bilateral TAP block application, USG will be placed transversely on the mid-axillary
line between the iliac crest and subcostal planes. Using the In Plane technique, the
block needle will be advanced into the fascial plane between the internal oblique and
transversus abdominis muscles and the location will be confirmed by administering 5 ml of
saline . After the confirmation, 20 ml of 0.25% bupivacaine was administered for each
group for a total of 40 ml of local anesthetic. Blocks were applied using an 80 mm
sonovisible needle with a 6-10 MHz linear probe under the guidance of a portable
ultrasound. Same procedure applied to the contralateral side.
Inclusion Criteria:
- Adult patients older than 18 years of age who underwent elective laparoscopic
cholecystectomy under general anesthesia and were American Society of
- Anesthesiologists (ASA) I-II-III according to the ASA risk classification.
Exclusion Criteria:
- Patients who did not give consent,
- patients with coagulopathy,
- patients with signs of infection at the block application site,
- patients using anticoagulants,
- patients with local anesthetic drug allergies,
- patients undergoing open surgery,
- patients with unstable hemodynamics,
- patients who could not cooperate during postoperative pain assessment
Medicana Sivas Hospital
Sivas, Turkey
Investigator: Hüseyin Özden, associate professor
Contact: +905070117130
md.huseyinozden@gmail.com
Not Provided