Rauf Jassim, A M Haji Mohammad Mohsin
Department of Anesthesiology, ICU & Perioperative Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
Local Reg Anesth. 2024 Nov 13;17:93-97. doi: 10.2147/LRA.S482038. eCollection 2024.
Modified thoracoabdominal nerve block through the perichondrial approach (M TAPA), described by Tulgar et al in 2019, is a relatively new block. The block is relatively superficial and easy to perform. It has been successfully used in various laparoscopic surgeries and has been shown to reduce the perioperative opioid requirements.
We report the case of a 41-year-old male with ASA grade 2, who was scheduled to undergo laparoscopic unilateral inguinal hernia repair. The patient had General Anaesthesia with bilateral M TAPA using 30 mL of 0.25% levobupivacaine on each side before the incision. Intraoperatively, the surgeon decided that the patient would require bilateral inguinal hernia repair. The patient received 100 µg fentanyl at induction, and intravenous paracetamol and ketorolac intraoperatively. The surgery was uneventful, and the patient was transferred to a post anaesthesia care unit. In the postoperative period, the patient did not require opioids and received only two doses each of paracetamol and ketorolac. The patient was discharged the following day, without any further sequelae.
When administered bilaterally, MTAPA can provide adequate analgesia and has opioid-sparing effects in both the intra and postoperative periods.
改良胸腹神经经软骨膜途径阻滞（MTAPA）是图尔加尔等人在2019年描述的一种相对较新的阻滞方法。该阻滞相对表浅且易于实施。它已成功应用于各种腹腔镜手术，并已显示可减少围手术期阿片类药物的用量。
我们报告一例41岁、美国麻醉医师协会（ASA）分级为2级的男性患者，计划接受腹腔镜单侧腹股沟疝修补术。患者在切口前接受全身麻醉，双侧采用MTAPA，每侧使用30毫升0.25%左旋布比卡因。术中，外科医生决定患者需要进行双侧腹股沟疝修补术。患者诱导期接受100微克芬太尼，术中静脉注射对乙酰氨基酚和酮咯酸。手术过程顺利，患者被转至麻醉后护理单元。术后，患者不需要使用阿片类药物，仅接受了两剂对乙酰氨基酚和酮咯酸。患者次日出院，无任何后遗症。
双侧应用MTAPA时，在术中和术后均可提供充分的镇痛效果，并具有阿片类药物节省作用。
