Clinical Experience for Modified Thoracoabdominal Nerve Block Through Perichondrial Approach (M-TAPA) in Five Patients. Dermatomal Evaluation and Application of Different Volumes: A Case Series and Review of Literature

Background Laparoscopic renal cyst decompression (LRCD) is a common procedure in urology, but postoperative pain remains a significant challenge. While regional nerve blocks provide more targeted pain relief, there is no universally accepted pain management strategy for LRCD. The ultrasound-guided modified thoracoabdominal nerve block (M-TAPA) may offer effective analgesia by blocking the anterior and lateral branches of the intercostal nerves (T5-T12). However, its efficacy in LRCD has not been thoroughly evaluated. Objective This study aimed to assess the efficacy and safety of unilateral M-TAPA in reducing postoperative pain and opioid consumption in patients undergoing LRCD, and to evaluate its potential benefits in enhancing recovery. Methods In this randomized, double-blind, controlled trial, 61 patients undergoing LRCD were assigned to either the M-TAPA group (n = 31) or the Control group (n = 30). The M-TAPA group received ultrasound-guided nerve block, while the Control group received a placebo injection following general anesthesia. Postoperative pain was assessed using the numerical rating scale (NRS) over a 48-hour period. Additional outcomes included opioid consumption and opioid-related side effects, such as nausea and vomiting. Results The M-TAPA group had significantly lower NRS scores at all time points compared to the Control group, with the largest difference observed at 6 hours postoperatively (4.27 ± 0.83 in the Control group vs. 2.19 ± 0.54 in the M-TAPA group). Repeated measures ANOVA revealed a significant interaction between time and treatment (F = 20.813, p < 0.001). Opioid consumption was reduced by 22% in the M-TAPA group over 48 hours (P < 0.001), and the need for antiemetic drugs was significantly lower (P = 0.020). No M-TAPA-related complications were observed. Conclusion M-TAPA was found to be an effective method for reducing postoperative pain and opioid consumption in patients undergoing LRCD.

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Ultrasound-Guided Bilateral Modified-Thoracoabdominal Nerve Block Through a Perichondral Approach in a Patient Undergoing Bilateral Laparoscopic Inguinal Hernia Repair: A Case Report

Rauf,

A M Haji

2024

LRA

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Background Modified thoracoabdominal nerve block through the perichondrial approach (M TAPA), described by Tulgar et al in 2019, is a relatively new block. The block is relatively superficial and easy to perform. It has been successfully used in various laparoscopic surgeries and has been shown to reduce the perioperative opioid requirements. Case Presentation We report the case of a 41-year-old male with ASA grade 2, who was scheduled to undergo laparoscopic unilateral inguinal hernia repair. The patient had General Anaesthesia with bilateral M TAPA using 30 mL of 0.25% levobupivacaine on each side before the incision. Intraoperatively, the surgeon decided that the patient would require bilateral inguinal hernia repair. The patient received 100 µg fentanyl at induction, and intravenous paracetamol and ketorolac intraoperatively. The surgery was uneventful, and the patient was transferred to a post anaesthesia care unit. In the postoperative period, the patient did not require opioids and received only two doses each of paracetamol and ketorolac. The patient was discharged the following day, without any further sequelae. Conclusion When administered bilaterally, MTAPA can provide adequate analgesia and has opioid-sparing effects in both the intra and postoperative periods.

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Clinical Experience for Modified Thoracoabdominal Nerve Block Through Perichondrial Approach (M-TAPA) in Five Patients. Dermatomal Evaluation and Application of Different Volumes: A Case Series and Review of Literature

Cited by 5 publications

References 13 publications

The key to success in blocking lateral cutaneous branches with re-modified thoracoabdominal nerves block through perichondrial approach: a newly discovered space between the endothoracic fascia, diaphragm, and costodiaphragmatic recess

The key to success in blocking lateral cutaneous branches with re-modified thoracoabdominal nerves block through perichondrial approach: a newly discovered space between the endothoracic fascia, diaphragm, and costodiaphragmatic recess

Ultrasound-guided Modified Thoracoabdominal Nerve Block for Postoperative Analgesia in Laparoscopic Renal Cyst Decompression: A Randomized Double-blind Controlled Trial

Ultrasound-Guided Bilateral Modified-Thoracoabdominal Nerve Block Through a Perichondral Approach in a Patient Undergoing Bilateral Laparoscopic Inguinal Hernia Repair: A Case Report

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