Comparison of Postoperative Analgesic Effects of M-TAPA and Anterior Quadratus LumborumBlocks in Laparoscopic Cholecystectomies.
In trunk blocks, the interfascial area between the anterior abdominal wall or back
muscles is targeted. Local anesthetics are used for this purpose. Since there is no blood
circulation and vascularization in the interfascial areas, the absorption of local
anesthetics is slow, providing long-lasting analgesia. Therefore, they are used as a part
of multimodal analgesia. The effectiveness of trunk blocks can vary depending on the
patient's anatomical differences and previous surgeries, but on average, analgesic
effectiveness lasts for 8-12 hours. Sometimes analgesic effectiveness extending up to 24
hours has been reported.
In laparoscopic cholecystectomy operations, pain plays a role in postoperative
atelectasis, pneumonia due to atelectasis, prolonged hospital stay, and discharge. To
reduce the use of opioids due to their side effects such as nausea, vomiting, itching,
constipation, and addiction, opioid-free analgesia is applied, and regional techniques
are used. Quadratus lumborum blocks and M-TAPA blocks have been safely and easily applied
in abdominal surgery in recent years thanks to developments in trunk blocks and
ultrasound technology, and they are frequently preferred.
Procedure: anterior Quadratus lumborum block
Patients are placed in the lateral decubitus position. The area where the block will be
applied is disinfected with povidine iodine. A convex ultrasound probe is placed on the
midaxillary line above the iliac crest. By visualizing the transverse process adjacent to
the psoas major and quadratus lumborum muscles, using the in-plane technique, using a 22
gauge 80 mm peripheral block needle after negative aspiration into the anterior layer of
the thoracolumbar fascia anterior to the quadratus lumborum muscle muscle, 0.5-1 ml of
serum After observing hydrodissection with physiological, 20 ml of 0.25% bupivacaine is
injected. The same is done to the opposite side.
Procedure: M-TAPA BLOCK
In the M-TAPA block group, with the patient in the supine position, a linear
high-frequency linear ultrasound (USG) probe is angled to visualize the inferior surface
of the costochondral junction at the level of the 10th costochondral cartilage. Under
sterile conditions, using the in-plane technique with a 22G 80 mm peripheral block
needle, the needle is advanced posterior to the 10th costal cartilage by taking the lower
edge of the cartilage in the sagittal plane as the midline. After hydrodissection with
2-3 ml isotonic saline to confirm the site, 20 ml of 0.25% Bupivacaine is administered
under USG guidance. The same procedure is performed on the contralateral side as well.
- Inclusion Criteria:
- scheduled for elective Laparoscopic chplecystectomy
- Patients aged ≥18 years
- American Society of Anesthesiologists physical status (ASA) Ⅰ-II
Exclusion Criteria:
ASA III-IV patient
- local anesthetic allergy
- Infection at the procedure site Body Mass Index >35 kg/m2 Anticoagulant use with
bleeding disorder Chronic analgesia and opioid use with mental and psychiatric
disorders Contraindications to regional anesthesia several lung and heart disease
Gaziosmanpasa Research and Education Hospital
Istanbul 745044, Turkey (Türkiye)