After cholecystectomy, modified-thoracoabdominal nerve block (M-TAPA) is a newly appliedtechnique in upper abdominal surgery for postoperative analgesia. In recent years, blockmethods such as erector spina plane (ESP), paravertebral (PVB), transverses abdominisplane (TAP) have also been applied in these surgeries. MTAPA has been defined as atechnique that is performed in the supine position and is easier to apply than the othermentioned blocks. In our study, we aimed to investigate the effectiveness of this block.
After laparoscopic cholecystectomy, most patients experience moderate to severe pain,
especially in the first 24 hours. The cause of the pain is the skin incision, the carbon
dioxide insufflation given into the abdomen for laparoscopy, and the visceral peritoneum.
This pain that occurs in the postoperative period negatively affects the patient's early
mobilization, wound healing, and patient comfort. While the toxic effects of nonsteroids
used for pain control on the liver and kidneys are known, narcotic analgesics have side
effects such as nausea, vomiting, and addiction. In recent years, trunk blocks have begun
to be used frequently for pain control in abdominal surgery. Although blocks such as
erector spina plane (ESP), paravertebral (PVB), and transverses abdominis plane (TAP) are
frequently applied, there are differences in terms of their effectiveness and duration.
On the other hand, it is important to give the patient a suitable position for the
application.
Modified-thoracoabdominal nerve block (M-TAPA), which is applied especially in the supine
position and is easier to apply compared to other blocks, has started to be applied as an
alternative method.
In our study, we aimed to compare the effectiveness and duration of the MTAPA block
compared to other trunk blocks such as ESP.
Procedure: M TAPA block
Grup M: The patients who underwent M-TAPA block were placed in the supine position. The
right upper quadrant of the abdomen was cleaned with antiseptic solution. For the block
procedure, 20-30 ml of 0.25% bupivacaine, 22G 8.5 cm stimuplex needle and 10-14 Hz high
frequency USG were prepared for the procedure. The USG probe was determined in the
costochondral area at the mid-clavicular line, and the internal and transversus abdominis
muscles were determined. The needle was advanced with the in plane technique from
cephalad to caudal, passing through the skin, subcutaneous, external and internal oblique
muscles, respectively, and then over the transversus abdominis fascia. After the target
was confirmed with 2 ml of saline, 0.3 mg / kg bupivacaine (20-30 ml) was administered.
Procedure: ESP block group
In Group E, patients who were to undergo ESP block were placed in the lateral position
with the right side up. The T8-T10 dorsal region was cleaned appropriately with
antiseptic solution. For the block procedure, 20-30cc %0.25 bupivacaine, 22G 8.5cm
stimuplex needle and 10-14Hz high frequency USG were prepared for the procedure.
The USG probe is first determined in the sagittal direction, the spinous process of the
T10 thoracic vertebra is then followed 1-2 cm above the transverse process, with the in
plane technique, the skin, subcutaneous tissue and erector spina muscle are passed, the
needle is touched to the transverse process and the target is confirmed with 2cc saline,
then 20-30 cc (0.5 mg / kg bupivacaine) of local anesthetic is administered and the
procedure is terminated.
Inclusion Criteria: ASAI-III , 18-70 yaş, elective surgery -
Exclusion Criteria: pregnancy, patient with emegency, patients allergic to local
anesthetics, patient with coagülopaty, uncooperative, mentally retarded patients
-
University of Gaziantep
Şehitkamil 7619145, Gaziantep 314829, Turkey (Türkiye)
Not Provided