Modified thoracoabdominal nerves block through the perichondral approach (M-TAPA) was recently reported to provide broad analgesia with only a single injection of local anesthetics (LA) on each side. However, the effectiveness of M-TAPA in laparoscopic cholecystectomy (LC) is not often reported. We retrospectively evaluated the analgesic efficacy of M-TAPA in patients who underwent LC and compared it with conventional LA infiltration (LAI) by calculating the propensity score. The primary outcome was the frequency of analgesic use after surgery. Although there was no difference in the frequency of analgesic use within 48 hours (P = .063), there was significantly less analgesic use 24-48 hours after surgery in the TAPA group (P = .02). Intraoperative remifentanil administration also significantly decreased in the TAPA group (P < .001). We found that preincisional M-TAPA may have an advantage over LAI with respect to analgesia on postoperative day 1.laparoscopic cholecystectomy, modified thoracoabdominal nerves block through the perichondral approach (M-TAPA), pre-emptive analgesia

A 52-year-old man underwent laparoscopic cholecystectomy. Preoperative electrocardiogram (ECG) showed flat T at I and aVL leads but his echocardiogram showed no abnormalities. Epidural catherization was performed at the Th8-9 interspace. Anesthesia was induced with propofol, fentanyl and vecuronium. His blood pressure suddenly decreased from 100/45 mmHg to 78/40 mmHg after pneumoperitoneum. Ephedrine was given and the blood pressure increased to 90/45 mmHg and the ECG showed a marked elevation of the ST-segment. Isosorbide dinitrate was given intravenously and ST-segment elevation gradually normalized within 5 minutes.The transient elevation of ST-segment might be due to coronary artery spasm induced by ephedrine.

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