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Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) vs local infiltration for pain management after laparoscopic cholecystectomy surgery: a randomized study

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A Letter to the Editor to this article was published on 30 March 2023

Abstract

Purpose

Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) targets thoracoabdominal nerves. Our primary aim was to compare M-TAPA vs local infiltration on pain management in patients underwent laparoscopic cholecystectomy (LC) surgery.

Methods

Patients with ASA class I-II patients aged between 18 and 65 years scheduled for elective LC under general anesthesia were enrolled in the study. There were two randomized groups: Group M: M-TAPA group (n = 30) and the local infiltration (LI) group (n = 30). M-TAPA was performed with totally 40 ml 0.25% bupivacaine in the M group. LI was performed in infiltration group. The primary outcome of the study was pain score in the PACU, the secondary outcomes were the patient satisfaction scores, rescue analgesic need, and adverse effects during the 24-h postoperative period.

Results

The static NRS scores were significantly lower in Group M at the postoperative first 4 h (p = 0.001). There was a significant decrease in the dynamic NRS scores in Group M at the postoperative first 16 h (p = 0.001). The incidence of nausea was significantly higher in the LI group (12 vs. 5 patients, p = 0.047). The need for rescue analgesia was significantly lower in Group M (p = 0.009). The patient satisfaction scores were significantly higher in Group M (p = 0.001).

Conclusion

M-TAPA provides superior analgesia compared to LI in patients undergoing LC.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

References

  1. Kapoor T, Wrenn SM, Callas PW, Abu-Jaish W. Cost analysis and supply utilization of LC. Minim Invasive Surg. 2018;10(2018):7838103.

    Google Scholar 

  2. Mitra S, Khandelwal P, Roberts K, Kumar S, Vadivelu N. Pain relief in LC—a review of the current options. Pain Pract. 2012;12:485–96.

    Article  PubMed  Google Scholar 

  3. Donatsky AM, Bjerrum F, Go ̈genur I. Surgical techniques to minimize shoulder pain after LC. A systematic review. Surg Endosc. 2013;27:2275–82.

    Article  PubMed  Google Scholar 

  4. Blichfeldt-Eckhardt MR, Ording H, Andersen C, Licht PB, Toft P. Early visceral pain predicts chronic pain after laparoscopic chole- cystectomy. Pain. 2014;155(11):2400–7.

    Article  PubMed  Google Scholar 

  5. Oderda GM, Said Q, Evans RS, et al. Opioid-related adverse drug events in surgical hospitalizations: Impact on costs and length of stay. Ann Pharmacother. 2007;41:400–6.

    Article  PubMed  Google Scholar 

  6. Tulgar S, Senturk O, Selvi O, Balaban O, Ahiskalioğlu A, Thomas DT, Ozer Z. Perichondral approach for blockage of thoracoabdominal nerves: Anatomical basis and clinical experience in three cases. J Clin Anesth. 2019;54:8–10. https://doi.org/10.1016/j.jclinane.2018.10.015. (Epub 2018 Oct 31. PMID: 30388604).

    Article  PubMed  Google Scholar 

  7. Tulgar S, Selvi O, Thomas DT, Deveci U, Özer Z. Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides effective analgesia in abdominal surgery and is a choice for opioid sparing anesthesia. J Clin Anesth. 2019;55:109. https://doi.org/10.1016/j.jclinane.2019.01.003. (Epub 2019 Jan 9. PMID: 30639940).

    Article  PubMed  Google Scholar 

  8. Ciftci B, Alici HA, Ansen G, Sakul BU, Tulgar S. Cadaveric investigation of the spread of the thoracoabdominal nerve block using the perichondral and modified perichondral approaches. Korean J Anesthesiol. 2022;75(4):357–9. https://doi.org/10.4097/kja.22137. (Epub 2022 Apr 26. PMID: 35468713).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Aikawa K, Yokota I, Maeda Y, Morimoto Y. Evaluation of sensory loss obtained by modified-thoracoabdominal nerves block through perichondrial approach in patients undergoing gynecological laparoscopic surgery: a prospective observational study. Reg Anesth Pain Med. 2022;47(2):134–5. https://doi.org/10.1136/rapm-2021-102870. (Epub 2021 Jul 20. PMID: 34285115).

    Article  PubMed  Google Scholar 

  10. Ohgoshi Y, Ando A, Kawamata N, Kubo EN. Continuous modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) for major abdominal surgery. J Clin Anesth. 2020;60:45–6. https://doi.org/10.1016/j.jclinane.2019.08.031. (Epub 2019 Aug 20. PMID: 31442859).

    Article  PubMed  Google Scholar 

  11. de Oliveira EJSG, De Lima RC, Sakata RK, Freire TT, de Almeida Lima EL, de Oliveira CMB, Moura ECR, da Cunha LP. Modified thoracoabdominal nerve block through the perichondral approach (M-TAPA) in laparoscopic sleeve gastroplasty: a case series. Obes Surg. 2022;32(1):197–201. https://doi.org/10.1007/s11695-021-05612-6. (Epub 2021 Aug 2. PMID: 34339018).

    Article  PubMed  Google Scholar 

  12. Aikawa K, Tanaka N, Morimoto Y. Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides a sufficient postoperative analgesia for laparoscopic sleeve gastrectomy. J Clin Anesth. 2020;59:44–5. https://doi.org/10.1016/j.jclinane.2019.06.020. (Epub 2019 Jun 15. PMID: 31212124).

    Article  PubMed  Google Scholar 

  13. Tulgar S, Senturk O, Selvi O, Balaban O, Ahiskalioğlu A, Thomas DT, Ozer Z. Perichondral approach for blockage of thoracoabdominal nerves: anatomical basis and clinical experience in three cases. J Clin Anesth. 2019;54:150–1. https://doi.org/10.1016/j.jclinane.2018.12.005.

  14. Bhatia N, Arora S, Jyotsna W, Kaur G. Comparison of posterior and subcostal approaches to ultrasound-guided transverse abdominis plane block for postoperative analgesia in LC. J Clin Anesth. 2014;26(4):294–9. https://doi.org/10.1016/j.jclinane.2013.11.023. (Epub 2014 Jun 2. PMID: 24882606).

    Article  PubMed  Google Scholar 

  15. Saxena R, Joshi S, Srivastava K, Tiwari S, Sharma N, Valecha UK. Comparative study of ultrasound-guided abdominal field blocks versus port infiltration in laparoscopic cholecystectomies for post-operative pain relief. Indian J Anaesth. 2016;60(8):578–83. https://doi.org/10.4103/0019-5049.187790. (PMID: 27601741; PMCID: PMC4989809).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Bilge A, Başaran B, Et T, Korkusuz M, Yarımoğlu R, Toprak H, Kumru N. Ultrasound-guided bilateral modified-thoracoabdominal nerve block through a perichondrial approach (M-TAPA) in patients undergoing laparoscopic cholecystectomy: a randomized double-blind controlled trial. BMC Anesthesiol. 2022;22(1):329. https://doi.org/10.1186/s12871-022-01866-4. (PMID: 36307755;PMCID: PMC9615166).

    Article  PubMed  PubMed Central  Google Scholar 

  17. El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: current perspectives. Local Reg Anesth. 2018;8(11):35–44. https://doi.org/10.2147/LRA.S154512. (PMID: 30122981; PMCID: PMC6087022).

    Article  Google Scholar 

  18. Grape S, Kirkham KR, Akiki L, Albrecht E. Transversus abdominis plane block versus local anesthetic wound infiltration for optimal analgesia after laparoscopic cholecystectomy: a systematic review and meta-analysis with trial sequential analysis. J Clin Anesth. 2021;75:110450. https://doi.org/10.1016/j.jclinane.2021.110450. (Epub 2021 Jul 6. PMID: 34243030).

    Article  PubMed  Google Scholar 

  19. Canıtez A, Kozanhan B, Aksoy N, Yildiz M, Tutar MS. Effect of erector spinae plane block on the postoperative quality of recovery after laparoscopic cholecystectomy: a prospective double-blind study. Br J Anaesth. 2021;127(4):629–35. https://doi.org/10.1016/j.bja.2021.06.030. (Epub 2021 Jul 31 PMID: 34340839).

    Article  CAS  PubMed  Google Scholar 

  20. Altiparmak B, Toker MK, Uysal Aİ, Kuşçu Y, Demirbilek SG. Eficácia do bloqueio do plano do músculo eretor da espinha guiado por ultrassom para analgesia após colecistectomia laparoscópica: um estudo controlado randômico [Efficacy of ultrasound-guided erector spinae plane block for analgesia after laparoscopic cholecystectomy: a randomized controlled trial]. Braz J Anesthesiol. 2019;69(6):561–8. https://doi.org/10.1016/j.bjan.2019.09.001. (Epub 2019 Dec 9. PMID: 31822353; PMCID: PMC9621114).

    Article  PubMed  PubMed Central  Google Scholar 

  21. Liu QR, Dai YC, Xie J, Li X, Sun XB, Sun J. Ultrasound-guided quadratus lumborum block enhances the quality of recovery after gastrointestinal surgery: a randomized controlled trial. Pain Res Manag. 2022;30(2022):8994297. https://doi.org/10.1155/2022/8994297. (PMID:35535242;PMCID:PMC9078840).

    Article  Google Scholar 

  22. Zinboonyahgoon N, Luksanapruksa P, Piyaselakul S, Pangthipampai P, Lohasammakul S, Luansritisakul C, Mali-Ong S, Sateantantikul N, Chueaboonchai T, Vlassakov K. The ultrasound-guided proximal intercostal block: anatomical study and clinical correlation to analgesia for breast surgery. BMC Anesthesiol. 2019;19(1):94. https://doi.org/10.1186/s12871-019-0762-2. (PMID: 31164083; PMCID: PMC6549312).

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ohgoshi Y, Kawagoe I, Ando A, Ikegami M, Hanai S, Ichimura K. Novel external oblique muscle plane block for blockade of the lateral abdominal wall: a pilot study on volunteers. Can J Anaesth. 2022. https://doi.org/10.1007/s12630-022-02310-4. (Epub ahead of print. PMID: 35999334).

    Article  PubMed  Google Scholar 

  24. Hill J, Ashken T, West S, Macfarlane AJR, El-Boghdadly K, Albrecht E, Chin KJ, Fox B, Gupta A, Haskins S, Haslam N, Hogg RMG, Hormis A, Johnston DF, Mariano ER, Merjavy P, Moll T, Parry J, Pawa A, Russon K, Sebastian MP, Turbitt L, Womack J, Chazapis M. Core outcome set for peripheral regional anesthesia research: a systematic review and Delphi study. Reg Anesth Pain Med. 2022. https://doi.org/10.1136/rapm-2022-103751. (Epub ahead of print. PMID: 35863787).

    Article  PubMed  Google Scholar 

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Funding

The authors have no sources of funding to declare for this manuscript.

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Authors and Affiliations

  1. Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34040, Istanbul, Turkey

    Hande Güngör, Bahadir Ciftci & Selcuk Alver

  2. Department of Anesthesiology, Katip Çelebi University, Izmir, Turkey

    Birzat Emre Gölboyu

  3. Department of General Surgery, Istanbul Medipol University, Istanbul, Turkey

    Yasar Ozdenkaya

  4. Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun University, Samsun Training and Research Hospital, Samsun, Turkey

    Serkan Tulgar

Authors
  1. Hande Güngör
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  2. Bahadir Ciftci
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  3. Selcuk Alver
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  4. Birzat Emre Gölboyu
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  5. Yasar Ozdenkaya
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  6. Serkan Tulgar
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Contributions

All of the authors (HG, BC, SA, BEG, YO, ST) made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; they have been involved in drafting the manuscript or revising it critically for important intellectual content; have given final approval of the version to be published.

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Correspondence to Bahadir Ciftci.

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The authors declare no conflicts of interest.

Ethical approval

This study has been approved by Istanbul Medipol University Ethics and Research Committee (23.12.2021, decision no. 1335).

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Written informed consent was obtained from the participants. All methods were carried out in accordance with relevant guidelines and regulations.

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Güngör, H., Ciftci, B., Alver, S. et al. Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) vs local infiltration for pain management after laparoscopic cholecystectomy surgery: a randomized study. J Anesth 37, 254–260 (2023). https://doi.org/10.1007/s00540-022-03158-0

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  • DOI: https://doi.org/10.1007/s00540-022-03158-0

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