Bilgili Beliz, Güçlü Öztürk Ecem, Tanırgan Çabaklı Gamze, Cebecik Teomete Gülşen, Ergenç Merve
Marmara University Faculty of Medicine, Department of Anaesthesiology and Reanimation, İstanbul, Türkiye.
Marmara University Pendik Training and Research Hospital, Clinic of Anaesthesiology and Reanimation, İstanbul, Türkiye.
Turk J Anaesthesiol Reanim. 2025 Feb 11;53(1):12-19. doi: 10.4274/TJAR.2025.241752.
Modified thoracoabdominal nerve block with a perichondrial approach (M-TAPA) provides effective analgesia in the anterior and lateral thoracoabdominal regions. Previous studies have shown the efficacy of M-TAPA in laparoscopic surgery. The primary aim of this study was to investigate the efficacy of M-TAPA block in patients undergoing open major abdominal surgery.
This study was designed as a prospective, randomized, single-blind, controlled study. A total of 43 patients were included in the study. In group M-TAPA, the block was performed bilaterally at the end of the surgery. Local wound infiltration was performed on the control group. Postoperative analgesia was provided with patient-controlled intravenous morphine. When numeric rating scale (NRS) pain scores exceeded 4, rescue analgesia with tramadol was administered. The primary outcome of this study was to compare the 24-hour total morphine consumption. The secondary outcomes included comparing pain scores, rescue analgesia requirements, and patient satisfaction.
Regarding our primary outcome, median morphine consumption during the first 24 hours was lower in the M-TAPA group [16 (14-18)] than in the control group [24.5 (19.5-27)] ( < 0.01, 95% confidence interval: -9, 42 and -3.01). Additionally, NRS scores were significantly lower and patient satisfaction was significantly higher in the M-TAPA group. The need for rescue analgesics in the first 24 hours was comparable among the study groups.
The M-TAPA block is an effective abdominal wall block that can be considered part of multimodal analgesia in open major abdominal surgery.
改良软骨膜入路胸腹神经阻滞（M-TAPA）可在胸腹前外侧区域提供有效的镇痛效果。既往研究已证实M-TAPA在腹腔镜手术中的有效性。本研究的主要目的是探讨M-TAPA阻滞在接受开放性腹部大手术患者中的疗效。
本研究设计为一项前瞻性、随机、单盲、对照研究。共纳入43例患者。M-TAPA组在手术结束时双侧进行阻滞。对照组进行局部伤口浸润。术后采用患者自控静脉注射吗啡镇痛。当数字评分量表（NRS）疼痛评分超过4分时，给予曲马多进行补救镇痛。本研究的主要结局是比较24小时吗啡总消耗量。次要结局包括比较疼痛评分、补救镇痛需求和患者满意度。
关于我们的主要结局，M-TAPA组在最初24小时内的吗啡消耗量中位数[16（14-18）]低于对照组[24.5（19.5-27）]（<0.01，95%置信区间：-9，-42和-3.01）。此外，M-TAPA组的NRS评分显著更低，患者满意度显著更高。研究组在最初24小时内对补救镇痛药的需求相当。
M-TAPA阻滞是一种有效的腹壁阻滞，可被视为开放性腹部大手术多模式镇痛的一部分。
