Effects of Modified Thoracoabdominal Nerve Block Through Perichondrial Approach on Postoperative Pain and Analgaesic Consumption in Patients Undergoing Laparoscopic Cholecystectomy.

OBJECTIVE

To investigate postoperative analgaesic efficacy of modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) and its effect on opioid consumption in patients undergoing laparoscopic cholecystectomy (LC) surgery.

STUDY DESIGN

Randomised, controlled trial. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Sivas Cumhuriyet University, Sivas, Turkiye, from April to May 2023.

METHODOLOGY

The study was conducted in two randomised groups: M-TAPA (n = 21) and control group (CG) (no block) (n = 21). All patients had standard general anaesthesia. M-TAPA patients had bilateral M-TAPA block with 0.25% bupivacaine (total volume, 40 ml) at the end of the surgery. In contrast, CG patients had only tramadol for postoperative pain. A numerical rating scale (NRS) and visual analogue scale (VAS) were used for postoperative pain assessment. Total tramadol consumption was calculated.

RESULTS

M-TAPA's NRS and VAS scores were lower in postoperative 24 hours (p<0.05). Total tramadol consumption was 116.67 ± 32.91 mg in CG and 35.71 ± 39.19 mg in M-TAPA (p<0.001).

CONCLUSION

Bilateral M-TAPA block for postoperative pain control after LC surgery provided effective analgaesia for up to 24 hours and reduced total opioid consumption. Although the M-TAPA block is a novel approach, it will be a part of multimodal analgaesia for routine postoperative pain management in abdominal surgeries. However, more studies with higher numbers of patients will be needed.

KEY WORDS

Analgaesia, Bupivacaine, Laparoscopic cholecystectomy, Nerve block, Pain management.