The goal of this study is to compare the analgesic efficacy of M-TAPA block and TAP blockin patients undergoing laparoscopic inguinal hernia surgeries.
There will be three randomized groups: Group Control (no any block, n=30) Group M-TAPA
(n=30), Group TAP (n=30). All patients will have standard general anesthesia. Group
M-TAPA patients will receive bilateral M-TAPA block with 0.25% bupivacaine (total volume
of 40 ml). Group TAP patients will have bilateral lateral-TAP block with 0.25%
bupivacaine (total volume of 40 ml). All blocks will be performed at the end of the
surgery, before awakening the patients. All patients in the study will receive 50 mg
dexketoprofen and 1 gr paracetamol intravenos (i.v.) 10 minutes prior to skin closure.
All patients will have ibuprofen 3x400 mg in postoperative 24 hours (maximum dose 1200
mg/day). Numerical rating scale (NRS) will be used to assess postoperative pain on 1st,
6th, 12th, 18th and 24th hour after the surgery. 50 mg tramadol will be administered as a
rescue analgesic in all patients.Total tramadol consumption will be calculated.
Other: M-TAPA block with bupivacaine 25%
Following sterile conditions for bilateral M-TAPA block application, the transducer will
be inserted on the chondrium in the sagittal plane at the 9-10th rib level. Subsequently,
a deep angle will be created with the probe for visualization of the underside of the
costochondrium. The sonovisible needle tip will be placed just below the chondrium and
saline (5 ml) will be injected for site confirmation. After the confirmation, 20 ml of
0.25% bupivacaine will be administered for each group for a total of 40 ml of local
anesthetic. Blocks will be applied using an 80 mm sonovisible needle with a 6-10 MHz
linear probe under the guidance of a portable ultrasound. M-TAPA block with the same
standard technique and drug dose will be applied to the contralateral side for each group
of M-TAPA patients.
Other Name: Modified thoracoabdominal nerve block through perichondrial approach
Other: TAP block with bupivacaine 25%
After the necessary sterilization conditions established, the linear ultrasound probe
will be placed in the middle of the iliac crest with the end limit of the ribs. Starting
with skin, the layers in descending order, subcutaneous adipose tissue, external oblique
muscle, internal oblique muscle, transversus abdominis muscle, and peritoneum will be
identified. As the tip of the 80 mm sonovisible needle passes through the muscular layers
and fascia, the needle will be advanced in a controlled manner. After receiving the click
sensation (passage of the fascia of the internal oblique muscle), the location of the
needle will be fixed and 20 ml of 0.25% bupivacaine will be injected between internal
oblique and transversus abdominis muscles. Same procedure will be performed to the other
site. (40 ml local anesthetics in total)
Other Name: Transversus abdominis plane block
Inclusion Criteria:
- Adult patients older than 18 years of age who will undergo laparoscopic inguinal
hernia under general anesthesia and will be 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
Not Provided
Oğuz Gündoğdu
+905545945469
droguzgundogdu@gmail.com
Onur Avcı
+905301126408
dronuravci@gmail.com
Oğuz Gündoğdu, Principal Investigator
Sivas Cumhuriyet University School of Medicine, Anesthesiology and Reanimation