Evaluation of sensory loss obtained by modified-thoracoabdominal nerves block through perichondrial approach in patients undergoing gynecological laparoscopic surgery: a prospective observational study

Aikawa, Katsuhiro; Yokota, Isao; Maeda, Yoshitaka; Morimoto, Yuji

doi:10.1136/rapm-2021-102870

Cited by 17 publications

(22 citation statements)

References 8 publications

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“…In our study, we obtained a 90% chance of analgesia in the Th11 area; hence, analgesia may not be certainly achieved in the Th12 area (60%). The present study result is in agreement with that of the pinprick test study by Aikawa et al on laparoscopic gynecological surgery in terms of the certainty of the effect on Th8-10 in the anterior cutaneous branch region and the uncertainty of the effect on the lateral cutaneous branch region [12]. Similarly, the effect on the anterior cutaneous branch region Th12 could not be guaranteed, but we believe that the present study was more certain about Th11, as the previous study.…”

Section: Discussionsupporting

confidence: 89%

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Efficacy of modified thoracoabdominal nerves block through perichondrial approach in open gynecological surgery: a prospective observational pilot study and a cadaveric evaluation

et al. 2022

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Background Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) was first described as a peripheral nerve block by Tulgar in 2019. This technique provides an analgesic effective range from Th7–11 with a single puncture per side. Although the efficacy and effective duration of M-TAPA have been reported, further examination is required. Therefore, this study aimed to evaluate the analgesic range and effective duration of M-TAPA in open gynecologic surgery. Methods Following approval, 10 adult female patients scheduled for open radical hysterectomy via a vertical incision or laparotomy using a midline incision from under the xiphoid process to the symphysis pubis were enrolled. The primary outcome was the number of anesthetized dermatomes at 2 and 24 h postoperatively. Secondary outcomes included numerical rating scale scores and the total amount of fentanyl used. Cadaveric evaluation was performed to assess the spread of the dye. Results The median numbers (interquartile range) of anesthetized dermatomes at 2 and 24 h postoperatively were 6 (5–7) and 6.5 (5–7) in the anterior cutaneous branch area and 5 (4–7) and 7 (5–7) in the lateral cutaneous branch area, respectively. There was an 85% chance of simultaneously acquiring analgesia in areas innervated by Th8–11, including complete block in areas innervated by the anterior cutaneous branches of Th9–10. Cadaveric evaluation showed the spread of the dye in Th8–11. Conclusions M-TAPA may have analgesic effects in the areas supplied by the anterior cutaneous branches of Th8–11. Trail registration IRB approval (No.2700; registered on July 10, 2020) and registration (UMIN Clinical Trials Registry: UMIN000041137; registered on July 17, 2020).

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Section: Discussionsupporting

confidence: 89%

“…M-TAPA may show an extensive analgesic range in front of the abdomen, with a single puncture per side. The efficacy and effective duration of M-TAPA have been reported in several case reports [10,11] and one research report in laparoscopic surgery [12]; however, this subject requires further investigation, especially in laparotomy.…”

Section: Introductionmentioning

confidence: 96%

Efficacy of modified thoracoabdominal nerves block through perichondrial approach in open gynecological surgery: a prospective observational pilot study and a cadaveric evaluation

et al. 2022

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“…Dermatome L1 was tested 2 cm below the midpoint of the inguinal ligament, L2 at the midpoint of the anterior side of the thigh, L3 at the midpoint of the patella, L4 at the midpoint of the medial leg, L5 at the midpoint of the dorsum of the foot, S1 at the lateral side of the fifth toe, S2 at the midpoint of the popliteal crease and S3 at the ischial tuberosity. 16 …”

Section: Methodsmentioning

confidence: 99%

Evaluation of Sensory Loss Obtained by Circum-Psoas Blocks in Patients Undergoing Total Hip Replacement: A Descriptive Pilot Study

Shi

Shao

et al. 2022

JPR

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Purpose The transversalis fascia (TF) encases the quadratus lumborum and psoas major (PM) muscles, respectively, after they split caudalward approximately at the level of the iliac crest. The branches of the lumbar plexus variably exit medially and laterally from the TF-encased PM muscle. We hypothesized that the local anesthetic (LA) injections around the anterolateral edge of PM at the supra-iliac level and into the retro-psoas compartment at the L5/S1 level, which termed as the circum-psoas blocks, could block the lumbar plexus branches. Therefore, here we evaluated the sensory loss caused by the circum-psoas blocks. Methods A total of 26 patients scheduled for total hip replacement were recruited for the study. After anesthesia induction, the ultrasound-guided circum-psoas blocks were performed in the lateral position with the affected side upward, in which the 0.3% ropivacaine was injected posterior to the TF and around the anterolateral edge of PM muscle at the supra-iliac level (25 mL), and into the retro-psoas compartment at the L5/S1 level (20 mL). The sensory block dermatomes and the muscle strength of quadriceps femoris were evaluated at 2 h or 6 h after surgery, respectively. The postoperative pain scores and opioid consumption were recorded. Results The median (interquartile range) highest and lowest dermatomes of sensory block were T10 (T9–T10) and S2 (S2–S2), respectively. The muscle strength of the quadriceps femoris evaluated at 6 h post-surgery was 4 (4–5) points. Total postoperative equivalent milligrams of oral morphine consumption in the first 24 h were 11.3 ± 3.6 mg. Conclusion The circum-psoas blocks may be a promising approach for postoperative analgesia of hip surgery, since they provide a dermatomal coverage of sensory block from T8–11 to S1–3. Clinical Trial Registration Chinese Clinical Trial Registry, clinical trial number ChiCTR2100051247.

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“…Therefore, injecting LA at the point where these three muscles intersect would provide abdominal analgesia through thoracoabdominal nerve blockage [ 2 – 4 ]. Aikawa et al [ 5 ], in their study, evaluated sensory loss after performing the M-TAPA in patients undergoing gynecological surgery. In that study, the authors reported that the M-TAPA provided limited dermatomal coverage, with greater anterior sensorial loss compared with lateral sensorial loss.…”

mentioning

confidence: 99%

“…Since the thoracoabdominal nerves enter the subcutaneous area in the anterior abdominal wall as the anterior and lateral cutaneous branches of the skin, TAPA blocks may be a good alternative for abdominal analgesia due to its region of spread. The literature shows successful analgesia associated with the TAPA for several surgical procedures such as abdominal and gynecological laparoscopic surgery [ 2 , 3 , 5 ]. However, there may be limitations related to volume.…”

mentioning

confidence: 99%

Cadaveric investigation of the spread of the thoracoabdominal nerve block using the perichondral and modified perichondral approaches

Çiftçi

Alici²,

Ansen

et al. 2022

Korean J Anesthesiol

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Evaluation of sensory loss obtained by modified-thoracoabdominal nerves block through perichondrial approach in patients undergoing gynecological laparoscopic surgery: a prospective observational study

Cited by 17 publications

References 8 publications

Efficacy of modified thoracoabdominal nerves block through perichondrial approach in open gynecological surgery: a prospective observational pilot study and a cadaveric evaluation

Efficacy of modified thoracoabdominal nerves block through perichondrial approach in open gynecological surgery: a prospective observational pilot study and a cadaveric evaluation

Evaluation of Sensory Loss Obtained by Circum-Psoas Blocks in Patients Undergoing Total Hip Replacement: A Descriptive Pilot Study

Cadaveric investigation of the spread of the thoracoabdominal nerve block using the perichondral and modified perichondral approaches

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