Ultrasound-guided Modified Thoracoabdominal Nerve Plane Block (M-TAPA) is performed deepinto the costochondral aspect at the 9th-10th costal level by injecting local anestheticsdeep into the chondrium. It provides blockage of both the anterior and lateral cutaneousbranches of the thoracoabdominal nerve. As there are studies showing M-TAPA block to beeffective for postoperative analgesia for other abdominal surgeries, its effect onpatients undergoing living liver donor surgery has not been studied yet. We hypothesizethat M-TAPA block performed in living liver donors would reduce opioid consumption in thefirst 48 hours after surgery.
Open hepatic resection for living liver transplantation donor surgery can cause severe
postoperative pain and if not treated properly, may increase the risk of chronic pain
development, which has a significant impact on the patient's daily life quality. The use
of interfascial plane blocks for pain control has increased in recent years, as
ultrasonography (USG) has become a part of daily routine. Interfascial plane blocks
provide effective postoperative analgesia. Additionally, reducing postoperative opioid
consumption may be a useful strategy to provide hemodynamic stability and promote early
mobilization. Case reports state interfascial plane blocks to be effective and safe for
providing effective analgesia compared to systemic analgesia in living liver donor
surgeries. As studies are showing M-TAPA block to be effective for postoperative
analgesia for other abdominal surgeries, its effect on patients undergoing living liver
donor surgery has not been studied yet. We hypothesize that the M-TAPA block performed in
living liver donors would reduce opioid consumption in the first 48 hours after surgery.
Procedure: M-TAPA plane block
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 (Pajunk Sonoplex Nanoline Stim Cannula, Germany) 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 bilaterally (60 ml
in total).
Procedure: Postoperative pain management
For preemptive analgesia, morphine (Morfin ®) 0.05mg/kg and Ibuprofen 400mg IV
(Ibuprofen®) will be administered to all patients before the surgical incision. An
additional dose of ibuprofen 400mg IV, meperidine (Aldolan ®), and tramadol (Contramal®)
1mg/kg IV will be administered to all patients 30 minutes before wound closure.10 mcg/ml
fentanyl containing PCA will be connected to all patients without infusion and boluses
0,35 mcg/kg,15-minute lockout period, maximum 100 mcg per hour. Postoperative patient
evaluation will be performed by another anesthesiologist. If the NRS score is ≥ 4, 0.5
mg/kg IV meperidine (Aldolan®)will be administered as a rescue analgesic.
Inclusion Criteria: Patients American Society of Anesthesiologists (ASA) classification
I- II Scheduled for living liver donation surgery for liver transplantation under general
anesthesia
Exclusion Criteria: Patients
- with history of bleeding diathesis,
- receiving anticoagulant treatment,
- with allergies or sensitivity to drugs used,
- with an infection on the puncture site
- who do not accept the procedure or participate in the study
Istanbul Medipol University Mega Hospital Complex
Istanbul 745044, Bagcilar, Turkey (Türkiye)
Not Provided