Tanaka Nobuhiro, Ida Mitsuru, Suzuka Takanori, Kawaguchi Masahiko
Department of Anesthesiology, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan.
BMC Anesthesiol. 2024 Dec 28;24(1):478. doi: 10.1186/s12871-024-02878-y.
Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) is a trunk block that has been gaining attention for managing postoperative pain following abdominal surgeries since its first report in 2019. We conducted a scoping review on M-TAPA, aiming to comprehensively evaluate existing research, identify the gaps in knowledge, and understand the implications of M-TAPA.
This scoping review was conducted using databases including PubMed, Embase, Cochrane, and CINAHL to evaluate the clinical efficacy of M-TAPA on April 19, 2024. Background and outcomes including anesthetized dermatomes, postoperative pain, opioid consumption, quality of recovery, duration to perform, and plasma local anesthetic concentrations were assessed. All reports involving patients, including randomized controlled trials, observational studies, case series, and case reports regarding M-TAPA, were included without language or age restrictions. The included studies were analyzed based on their methodology and clinical relevance.
Anesthetized dermatomes were mainly observed in anterior cutaneous branch T7-11. Lateral cutaneous branch T8-10 also anesthetized; however, the probability was lower than anterior cutaneous branch area. M-TAPA has been investigated mostly in laparoscopic cholecystectomy; although its potential to outperform non-block and wound infiltration has been suggested, it did not clearly outperform the transversus abdominis plane block.
M-TAPA may be considered a promising technique for postoperative pain management in upper abdominal laparoscopic surgeries. Further studies are warranted to elucidate the precise mechanisms and broader surgical applications.
改良胸腹神经经软骨膜途径阻滞（M-TAPA）是一种躯干阻滞技术，自2019年首次报道以来，在腹部手术后疼痛管理方面受到了关注。我们对M-TAPA进行了一项范围综述，旨在全面评估现有研究，找出知识空白，并了解M-TAPA的意义。
本范围综述于2024年4月19日使用包括PubMed、Embase、Cochrane和CINAHL在内的数据库进行，以评估M-TAPA的临床疗效。评估了包括麻醉皮节、术后疼痛、阿片类药物消耗、恢复质量、操作持续时间和血浆局麻药浓度等背景和结果。所有涉及患者的报告，包括关于M-TAPA的随机对照试验、观察性研究、病例系列和病例报告，均纳入，无语言或年龄限制。根据其方法和临床相关性对纳入的研究进行分析。
主要在T7-11前皮支观察到麻醉皮节。T8-10外侧皮支也有麻醉，但概率低于前皮支区域。M-TAPA大多在腹腔镜胆囊切除术中进行了研究；尽管有人提出其优于非阻滞和伤口浸润的潜力，但它并没有明显优于腹横肌平面阻滞。
M-TAPA可能被认为是上腹部腹腔镜手术术后疼痛管理的一种有前景的技术。需要进一步研究以阐明其确切机制和更广泛的手术应用。
