Ultrasound-guided Modified Thoracoabdominal Nerve Plane Block (M-TAPA) is performed intothe costochondral aspect at the 9th-10th costal level by injecting local anesthetics deepinto the chondrium. It provides blockage of both the anterior and lateral cutaneousbranches of the thoracoabdominal nerve. Studies show that M-TAPA block is effective forpostoperative analgesia and other abdominal surgeries, but its effect on patientsundergoing LSG surgery has not yet been studied. The hypothesis is that the M-TAPA blockperformed in patients undergoing Laparoscopic Sleeve Gastrectomy (LSG) Operation wouldreduce opioid consumption in the first 24 hours period after surgery.
LSG is defined as first-line bariatric surgery for patients at high surgical risk with
better surgical outcomes. Effective postoperative pain management is essential for early
mobilization, and reduction of the risk of morbidity and mortality. Opioids, due to their
potent analgesic effects are used as a component of multimodal analgesia in the
postoperative period. Despite their advantages, opioids may be related to pulmonary
complications such as atelectasis and impaired alveolar gas exchange, apnea;
postoperative delayed recovery due to ileus, nausea, and vomiting; and prolonged hospital
stay. The use of interfascial plane blocks for pain management has increased recently, as
ultrasonography (USG) has become a part of daily routine. Interfascial plane blocks
provide effective postoperative analgesia.
Additionally, reducing postoperative opioid consumption helps to provide hemodynamic
stability and promote early mobilization. Studies are showing M-TAPA block to be
effective for postoperative analgesia for abdominal surgeries, and some studies continued
comparing its effect in laparoscopic sleeve gastrectomy with other plane blocks. There
are also case reports showing the effectiveness of the M-TAPA block in LSG patients.
M-TAPA block's effect on LSG patients has not been studied yet. The investigators
hypothesize that the M-TAPA block performed in patients undergoing laparoscopic sleeve
gastrectomy would reduce opioid consumption in the first 24-hour period after surgery.
Procedure: M-TAPA block
After the wound closure is completed and the patient is still under genaral anesthesia
the M-TAPA block ill be performed. As the patient is in the supine position, the
high-frequency linear US probe (11-12 MHz, Vivid Q) and a 22-G 80-mm needle (Stimuplex®
Ultra 360®, Braun, USA) will be placed in a sagittal position at the costochondral
junction at the level of the 9th and 10th ribs. After the rib and the external oblique,
internal oblique, and transversus abdominis muscles are visualized on USG, using an
in-plane technique, the block needle will be advanced and the block location will be
confirmed by injecting 5 ml of saline between the internal oblique and transversus
abdominis muscles. Once the block location is confirmed, 30 ml of 0.25% bupivacaine
(Buvicaine ®) will be applied on each side. The total volume will be 60 ml.
Procedure: Postoperative pain management
ibuprofen 400mg (Ibuprofen-PF®) intravenous (IV), and tramadol (Contramal®) 100 mg IV
will be administered to all patients 20 minutes before wound closure. After surgery,
Ibuprofen 400 mg will be given three times a day. A patient-controlled analgesia (PCA)
system containing 10 mcg/ml fentanyl will be provided to all patients without continuous
infusion. Patients can administer boluses of 0.35 mcg/kg with a 15-minute lockout period
and a maximum dose of 100 mcg per hour. Another anesthesiologist will assess patients
after surgery. If the patient's pain score (NRS) is 4 or higher, IV tramadol (Contramal®)
100 mg will be given as a rescue analgesic.
Inclusion Criteria: American Society of Anesthesiologists (ASA) classification II- III
Patients Scheduled for LSG under general anesthesia
-
Exclusion Criteria: Patients
- with a history of bleeding diathesis,
- receiving anticoagulant treatment,
- with allergies or sensitivity to drugs used,
- with an infection on the puncture site
- with a history of alcohol or drug addiction,
- with congestive heart failure
- with liver or kidney disease
- who do not accept the procedure or participate in the study
Istanbul Medipol University Mega Hospital Complex
Istanbul 745044, Bagcilar, Turkey (Türkiye)
Investigator: Ayse Ince, Assist Prof, MD
Contact: +905366774988
drayseince@gmail.com
ayşe ince, assist pof
+90 5366774988
drayseince@gmail.com
Not Provided