Title: Modified Thoracoabdominal Nerve Block through Perichondral Approach versus Oblique Subcostal Transversus Abdominus Plane Block for Analgesia after Laparoscopic Cholecystectomy, a Non-inferiority Randomized Trial

Document Type : Original Article

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Department of Anesthesia and Surgical Intensive Care, Mansoura University, Egypt.

Abstract

Background: Patients suffer a considerable degree of pain after laparoscopic cholecystectomy (LC). Oblique subcostal transversus abdominis plane (OSTAP) block was frequently used for pain relief following LC. Recently, OSTAP block showed inadequate pain control and heterogeneous analgesia coverage. The M-TAPA block possesses analgesic properties that are adequate for pain control after LC.
Methods: This prospective randomized trial enrolled 35 patients in each study group. After anesthesia induction and before skin incision, group M patients received bilateral M-TAPA block, while group S patients received bilateral OSTAP block.
Results: The data recorded showed a statistically significant decrease of the NRS score for group M at rest at 6, 12, and 24 hours after surgery (p 0.047, p 0.001, p 0.011 consecutively) and on cough at 6 and 12 hours after surgery (p 0.038, p 0.002 consecutively). The NRS score at rest showed a statistically significant decrease in Group M (2.1±0.5 for group S, 1.8±0.5 for group M, p 0.007. The intraoperative requirement for fentanyl boluses, the mean postoperative rescue analgesia for the first day, times of postoperative analgesic requests, the mean NRS score at rest, and the mean NRS score on cough were comparable in both groups.
Conclusion: Our study confirms the non-inferiority of M-TAPA block as an analgesic modality when compared to S-TAP block after LC surgeries. further studies are recommended in high-risk patients, like the morbidly obese and pediatric patients.

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