The aim is to compare the postoperative analgesic effects of Modified ThoracoAbdominalnerve block through Perichondrial Approach (M-TAPA) versus Rectus Sheath Block (RSB) inpatients undergoing laparotomy with midline abdominal incision.
Patients were divided into two randomized groups: Group 1 (S-TAP group, n=30) and Group 2
(RSB group, n=30). All patients will receive the same standard general anesthesia per
hospital protocol. All blocks will be applied with the same ultrasonography and block
equipment, and by the same physician. All patients will receive Paracetamol 1gr and
Dexketoprofen 50mg intravenous (IV) 10 minutes prior to skin closure. After the surgery
waqs completed, patients in Group 1 will receive modified thoracoabdominal nerve block
through perichondrial approach (M-TAPA) with 20 mL of 0.25% bupivacaine bilaterally (with
a total volume of 40 mL). Patients in Group 2 will receive rectus sheath block (RSB) with
20 mL of 0.25% bupivacaine bilaterally (with a total volume of 40 mL). Routine analgesic
procedure consisting of 3x1gr Paracetamol and 2x50mg Dexketoprofen will be followed
postoperatively for 24 hours. Numeric Rating Scale (NRS) will be used to assess
postoperative pain on 1st, 6th, 12th, 18th and 24th hours after the surgery. Tramadol
50mg IV will be administered as a rescue analgesic for all patients if NRS score is equal
to or higher than 4. Total Tramadol consumption will be calculated.
Procedure: Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA)
20 mL of 0.25% bupivacaine on each side
Procedure: Rectus Sheath Block
20 mL of 0.25% bupivacaine on each side
Inclusion Criteria:
- Adult patients older than 18 years of age who underwent laparotomy with midline
incision 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 with unstable hemodynamics,
- patients who could not cooperate during postoperative pain assessment
- patients who received ileostomy or colostomy
Sivas Cumhuriyet University
Sivas, Sivas, Turkey (Türkiye)
Oğuz Gündoğdu, Principal Investigator
Sivas Cumhuriyet University School of Medicine, Anesthesiology and Reanimation