In laparoscopic inguinal hernia surgeries, although the effects of classical transversusabdominis plane (TAP) and Modified thoracoabdominal nerve block through perichondrialapproach (m-TAPA) blocks on perioperative pain control and opioid consumption have beenevaluated in various studies using classical scaling methods, their impact onpostoperative recovery quality remains an area open for further research. In thisobservational study, the investigator's primary goal is to evaluate the effects oflateral approach TAP and m-TAPA blocks, which are routinely used for postoperativeanalgesia, on postoperative pain and recovery quality in patients undergoing laparoscopicinguinal hernia surgery, using the QoR-15 scale. The investigator's secondary goal is tocontribute to identifying the standard analgesia method that will reduce postoperativeopioid use, nausea, and vomiting, and improve recovery quality.
Laparoscopic surgery is widely used in the repair of inguinal hernias, but it can cause
moderate to severe postoperative pain. Perioperative pain management is essential for
ensuring early mobilization of patients, reducing postoperative side effects and hospital
stay durations, improving patient satisfaction, and preventing the development of chronic
pain after surgery. The quality of postoperative recovery is influenced by various
factors, such as the patient's preoperative characteristics, the type of surgery, the
level of postoperative pain, and analgesic methods. In recent years, alongside
traditional scales measuring classical parameters in evaluating postoperative recovery
quality, new measurement tools focusing on patient satisfaction have been developed. One
of these tools is the Quality of Recovery-15 (QoR-15) scale, which has been recommended
by the European Society of Anaesthesiology for use in clinical studies investigating
postoperative patient comfort and pain levels. This scale includes 15 questions across
five different areas evaluating postoperative recovery from various perspectives: pain,
physical comfort, physical independence, psychological support, and emotional state. The
result is a score between 0 and 150, with higher scores indicating better recovery
quality.
Ultrasound (USG)-guided abdominal plane blocks are an important part of multimodal
analgesia due to their ease of application, ability to provide long-lasting postoperative
analgesia, and potential to reduce opioid consumption. Various regional anesthesia
techniques can be used for pain control following laparoscopic inguinal hernia repair
surgeries (TransAbdominal Pre-Peritoneal approach-TAPP). Some of these techniques include
the Transversus Abdominis Plane (TAP) block and the Perichondrial Approach Modified
Thoracoabdominal Plane (m-TAPA) block. The TAP block is performed in the neurofascial
plane between the internal oblique and transversus abdominis muscles, creating a
dermatomal sensory block at the T6-L1 levels. It can be applied laterally, subcostally,
or posteriorly. The Perichondrial Approach Modified Thoracoabdominal Plane (m-TAPA) block
is used more recently in upper and lower abdominal surgeries to provide effective
analgesia due to its wider dermatomal coverage. The m-TAPA block is performed under
ultrasound guidance by injecting a local anesthetic between the costal cartilage and the
transversus abdominis muscle, providing abdominal analgesia from T4-L1 along the anterior
and lateral abdominal wall. Both TAP and m-TAPA blocks are regional analgesia techniques
commonly applied in our daily practice after abdominal surgeries. The choice of regional
anesthesia technique is determined based on the surgical region, type of surgery, and the
experience of the anesthesia team.
This study includes 60 patients aged 18-65 years, classified in the American Society of
Anesthesiologists (ASA) physical risk class I-III, who are scheduled to undergo elective
laparoscopic inguinal hernia repair surgery under general anesthesia at the General
Surgery Department of Fatih Sultan Mehmet Training and Research Hospital.Participants who
are planning to receive M-TAPA block defines as Group M-TAPA, and those who receive
lateral TAP block defines as Group TAP, with 30 patients in each group. After obtaining
ethical approval on 14.12.2023, patients will be informed about the study procedure one
day before surgery, and those who consent will sign an informed consent form. The QoR-15
questionnaire, used to assess anesthesia and surgical recovery quality, will be
administered to patients preoperatively, 24 hours post-surgery, and on the 15th
postoperative day. The results will be recorded for further analysis.
Inclusion Criteria:
- Patients who will undergo laparoscopic unilateral inguinal hernia surgery under
general anesthesia in elective conditions, by the General Surgery clinic between
January 10, 2024 and October 17, 2024
- Aged between 18-65 years, with a Body Mass Index (BMI) < 35 kg/m²,
- Having an American Society of Anesthesiologists (ASA) physical risk score of I-III,
- Patients who have given informed consent.
Exclusion Criteria:
- Patients who refuse to participate in the study
- Emergency surgeries
- Patients who will undergo recurrent or bilateral surgery
- Patients with a BMI ≥ 35 kg/m²
- Presence of local infection or hematoma at the application site
- Presence of coagulopathy
- History of known local anesthetic allergy or toxicity
- Patients with a history of hematological, renal, or hepatic diseases, or advanced
respiratory or cardiac failure
- Patients with difficulty in cooperation, Alzheimer's, dementia, or psychiatric and
neurological diseases
- Patients with a history of chronic analgesic use, chronic alcohol use, or substance
addiction
- Patients who do not speak Turkish or have a language barrier
Fatih Sultan Mehmet Training and Research Hospital
Istanbul, Turkey
Oznur Demiroluk, Associate Professor, Study Director
Fatih Sultan Mehmet Training and Research Hospital