Because laparoscopic procedures have a number of benefits over open procedures, they havecompletely changed the surgical industry.(1) Laparoscopic cholecystectomy (LC) is aminimally invasive technique that usually yields less discomfort following surgery,shorter hospital stays, and quicker patient recovery, plus it's an economical operation.Nevertheless, it results in moderate to severe pain.(2).By using regional anesthesiatechniques to effectively control pain and lessen the requirement for opioid analgesics,ERAS implementation has demonstrated significant decreases in opioid usage and improvedoverall patient outcomes (3). (4) To minimize the need for opioids, opioid sparinganesthesia employs a multimodal strategy that includes nonsteroidal anti-inflammatorymedications, paracetamol, local anesthetics (LA), and, if feasible, regional anesthetictechniques and regional analgesia. (5) With fewer systemic side effects, regionalanesthetic techniques-like nerve blocks-offer tailored pain treatment. The best regionalpain management strategy for LC surgery is still unknown, though.(4) ModifiedThoracoabdominal Nerves Block Through Perichondral Approach (M-TAPA) Block is a newtechnique defined as a modification of TAPA Block in which local anaesthetics areadministered only to the underside of the perichondral surface, creating a sensory blockbetween T5-T12 dermatomes. While the external oblique intercostal plane (EOIPB) blockprovides blockade of the lateral and anterior cutaneous branches of the intercostalnerves from T6/7 to T10/11.This study aims to compare the efficacy of both MTAPA andEOIPB in patients undergoing LC surgery .
Not Provided
Other: Bilateral Ultrasound Guidance M-TAPA
transversus abdominis, internal oblique, and external oblique muscles will be identified
on the costochondral angle in the sagittal plane at the 10th costal margin. deep angle
will be given to the costochondral angle at the edge of the 10th costa with the probe in
the sagittal direction to view the lower surface of the costal cartilage in the midline.
The needle will be inserted in the cranial direction using the in-plane technique, and
the needle tip will be moved to the posterior aspect of the 10th costal cartilage, and
saline (5 ml) will be injected to confirm the location by observing dissection between
internal oblique muscle and transversus abdominis muscle under the 10th costal cartilage,
and local anesthetic will be injected into the lower surface of the chondrium. The local
anesthetic to be used is bupivacaine 0.25% with Ultrasound Siemens® ACUSON X300 portable
scanner with a high frequency linear transducer (10 MHz) using A Quincke 22 G . x 3½ in.
(0.7x88 mm) A spinal needle
Other Name: Modified throacoabdominal plane block (M-TAPA),GROUP A
Procedure: Bilateral Ultrasound Guidance EOIPB
The patients will be positioned in the supine position with the ipsilateral arm in
abduction. The transducer will be positioned in a cephalad to caudad parasagittal plane
at the anterior axillary line at the level of the sixth and seventh ribs in line with the
xiphoid process. Using the in-plane technique, the needle will be advanced from cephalad
to caudad until the tip lies in the plane between the external oblique muscle and
intercostal muscles between the sixth and seventh ribs. Following hydro-dissection with 2
ml of 0.9% saline to confirm the correct needle tip position, LA injection will be given.
The same procedure will then be repeated on the contralateral
- Local anesthetics to be injected: iBupivacaine (0.25%)
- Dose : 25ml on each side
- Device to be used: Ultrasound Siemens® ACUSON X300 portable scanner with a
high-frequency linear transducer (10 MHz) that is covered in sterile plastic.
- Needle to be used : A Quincke 22 G . x 3½ inch (0.7x88 mm) spinal needle
Other Name: External Oblique Intercoastal Plane Block ( EOIPB ),GROUP B
Inclusion Criteria:
- Adults aged 18-65 years
- Scheduled for Laparoscopic cholecystectomy surgery
- ASA (American Society of Anaesthesiologists) physical status I-II
Exclusion Criteria:
- Known allergy to local anaesthetics
- Coagulopathy or anticoagulant use
- Infection at the site of block
- Chronic pain conditions
- Advanced liver or kidney failure
- History of abdominal surgery or trauma
- Alcohol or drug use
- Refusal to participate
- Chronic opioid consumption
- Use of painkillers in the preoperative 24hours
- Conversion to open surgery
- Body mass index ( BMI ) > 35
Faculity of medicine , Kasr Al Aini Hospitals , Cairo University
Cairo, Egypt
Investigator: Nora A Agiza, MD
Contact: 00201001881060
noraagiza@gmail.com
Miran M Abdelaziz Raslan, MSC
00201140646969
miranrs1994@gmail.com
Nora A Agiza, MD
00201001881060
noraagiza@gmail.com
Not Provided