The aim of the study is comparing the postoperative effects of ultrasound-guided ModifiedPerichondrial Approach to Thoracoabdominal Nerves (M-TAPA) block for postoperative paincontrol after total laparoscopic hysterectomy.
Pain is one of the most common problems seen in the postoperative period in patients who
underwent total laparoscopic hysterectomy.
Multimodal analgesia methods are used in postoperative pain management. Nerve blocks,
which are an important component of multimodal analgesia, have an important place in
postoperative analgesia management today.
Local Anesthetic Infiltration at the Trocar Site is the most classical nerve block method
that has been used for a long time as a part of multimodal analgesia in laparoscopic
surgeries.
Modified TAPA block applied with ultrasound guidance; It is a regional block affecting
both the anterior and lateral branches of the thoracoabdominal nerves with a
perichondrial approach. It is used in total laparoscopic hysterectomies.
Other: M-TAPA Block
M-TAPA block will administer ultrasound guided (Sonosite, Inc., Bothell, WA, USA)
bilaterally by same anesthesiologist (E.E.) who had more than 10 years experience of
regional anesthesia, before weaking from general anesthesia after the surgical procedure.
A high-frequency (6-13 MHz) linear probe (HFL38) will be used to identify the transversus
abdominis, internal oblique, and external oblique muscles on the costochondral angle in
the sagittal plane at the 10th costal margin. In the midclavicular line, between the
upper fascia of the transversus abdominis muscle and the lower fascia of the
costochondral tissue, at the level of the 10th rib, 20 mL of 0.25 percent bupivacaine
will be injected (arcus costarum). The same procedure will be followed on the other side.
Other: Trocar site local anesthetic infiltration
At the end of surgery, infiltration analgesia will be applied to all trocar entry sites
(4 port entries) by the surgeon with 10 ml of 0.25% bupivacaine (40 mL in total) without
waking the patient.
Inclusion Criteria:
- Ages 18-65
- Elective cases
- ASA I-III functional status
- Body mass index (BMI)<35
- Total laparoscopic hysterectomy planned with general anesthesia
- No contraindications for M-TAPA block to be applied
- Cases that give written and verbal consent for participation in the study will be
included.
Exclusion Criteria:
- Conversion to open surgery
- Development of perioperative complications (due to surgery and/or anesthesia)
- Coagulation disorder
- Infection at the injection site
- Allergy to local anesthesia
- Those who used any painkillers in the preoperative 24 hours
- Those who did not agree to participate in the study
Health Sciences University
Ankara, Turkey
Not Provided