Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides a sufficient postoperative analgesia for laparoscopic sleeve gastrectomy

Aikawa, Katsuhiro; Tanaka, Nobuhiro; Morimoto, Yuji

doi:10.1016/j.jclinane.2019.06.020

Cited by 23 publications

(18 citation statements)

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“…Tulgar et al initially reported an analgesic range of Th7-11 for M-TAPA with the administration of 25 mL 0.25% bupivacaine per side in laparoscopic ovariectomy and ileostomy [9]. Altiparmak et al reported a Th5-10 range with 20 mL 0.25% bupivacaine in laparoscopic ventral hernia repair, while Aikawa et al reported a Th3-12 range with 30 mL 0.25% ropivacaine in laparoscopic sleeve gastrectomy [10,11]. We decided to use a local anesthetic amount of 30 mL (0.25% ropivacaine) per side if the patient weighed ≥50 kg and 25 mL (0.25% ropivacaine) if the patient weighed between 42 and 50 kg to certainly cover Th11-12.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

“…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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“…[8] Altiparmak et al reported a Th5−Th10 range with 20 mL 0.25% bupivacaine in laparoscopic ventral hernia repair, while Aikawa et al reported a Th3−Th12 range with 30 mL 0.25% ropivacaine in laparoscopic sleeve gastrectomy. [9,10] We decided to use a local anesthetic amount of 30 mL (0.25% ropivacaine) per side if the patient weighed 50 kg or more and 25 mL (0.25% ropivacaine) if the patient weighed between 42 and 50 kg to certainly cover Th11-12. In our study, we obtained a 90% chance of analgesia in the Th11 area; hence, analgesia not be certainly achieved in the Th12 area (60%).…”

Section: Discussionmentioning

confidence: 99%

“…[8] M-TAPA may show an extensive analgesic range in front of the abdomen, with a single puncture per side. The e cacy and effective duration of M-TAPA have been reported in several case reports [9,10]; however, this subject requires further investigation.…”

Section: Trail Registrationmentioning

confidence: 95%

Efficacy of Modified Thoracoabdominal Nerves Block Through Perichondrial Approach in Open Gynecological Surgery: A Prospective Observational Study and a Cadaveric Evaluation

Tanaka

Suzuka

Kadoya

et al. 2021

Preprint

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BACKGROUNDː Modified thoracoabdominal nerve 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.METHODSː 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. RESULTSː 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–Th11, 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.CONCLUSIONSːM-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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“…It was previously reported that this technique creates a sensory block between T5-T12 dermatomes [ 11 ]. It has recently been used for postoperative analgesia in laparoscopic abdominal surgeries because it is considered to provide effective analgesia in the anterior and lateral thoracoabdominal walls [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Comparing ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach with oblique subcostal transversus abdominis plane block for patients undergoing laparoscopic cholecystectomy: a randomized, controlled trial

et al. 2023

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Background Laparoscopic cholecystectomy(LC) causes significant postoperative pain. Oblique subcostal transversus abdominis plane(OSTAP) block was described for postoperative analgesia, especially for upper abdominal surgeries. Modified thoracoabdominal nerves block through perichondrial approach(M-TAPA) block is a new technique defined by the modification of the thoracoabdominal nerves through perichondrial approach (TAPA) block, in which local anesthetics are delivered only to the underside of the perichondral surface. The primary aim of this study was to evaluate the effect of M-TAPA and OSTAP blocks as part of multimodal analgesia on postoperative opioid consumption in patients undergoing LC. Method The present study was designed as a randomized, controlled, prospective study. Seventy-six adult patients undergoing LC were randomly assigned to receive either bilaterally M-TAPA or OSTAP block after the induction of anesthesia and before surgery using bupivacaine 0.25%, 25 ml. The primary outcome was assessed as postoperative 24 h opioid consumption, between groups were compared. Secondary outcomes were Numerical Rational scale(NRS) scores, time to first opioid analgesia, patient recovery, using the Quality of Recovery-15 (QoR-15) scale, nausea and vomiting, sedation score, metoclopramide consumption, and evaluating the analgesic range of dermatome. Results The mean tramadol consumption at the postoperative 24th hour was higher in the group OSTAP than in group M-TAPA (P = 0.047). NRS movement score at 12th hour was statistically significantly lower in group M-TAPA than in group OSTAP (P = 0.044). Dermatomes showed intense sensory analgesia between T7-11 in both groups, and it was determined that there was proportionally more involvement in the group M-TAPA. There were no differences between the groups in terms of other results. Conclusions After the LC surgery, ultrasound-guided M-TAPA block effectively reduced opioid consumption, postoperative pain, and QoR-15 scores similar to OSTAP block. Clinical trial registration The study was registered prospectively at clinicaltrials.gov (trial ID: NCT05108129 on 4/11/2021).

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Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides a sufficient postoperative analgesia for laparoscopic sleeve gastrectomy

Cited by 23 publications

References 4 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

Efficacy of Modified Thoracoabdominal Nerves Block Through Perichondrial Approach in Open Gynecological Surgery: A Prospective Observational Study and a Cadaveric Evaluation

Comparing ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach with oblique subcostal transversus abdominis plane block for patients undergoing laparoscopic cholecystectomy: a randomized, controlled trial

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