Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides effective analgesia in abdominal surgery and is a choice for opioid sparing anesthesia

Tulgar, Serkan; Selvi, Onur; Thomas, David Terence; Deveci, Uğur; Özer, Zeliha

doi:10.1016/j.jclinane.2019.01.003

Cited by 45 publications

(40 citation statements)

References 4 publications

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“…Recently, Tulgar et al reported modified-thoracoabdominal nerves block through perichondrial approach (M-TAPA). 1 However, studies showing the area blocked by M-TAPA are lacking.…”

Section: Introductionmentioning

confidence: 99%

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

Aikawa

Yokota

Maeda

et al. 2021

Reg Anesth Pain Med

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“…Recently, Tulgar et al reported modified-thoracoabdominal nerves block through perichondrial approach (M-TAPA). 1 However, studies showing the area blocked by M-TAPA are lacking.…”

Section: Introductionmentioning

confidence: 99%

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

Aikawa

Yokota

Maeda

et al. 2021

Reg Anesth Pain Med

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“…Subcostal transversus abdominis plane block has been proven to block 90% of the midabdominal surface area and 26% of the lateral abdominal surface area, resulting in sensory blockage of T7-T12 dermatomes. Serratus intercostal plane block provides sensory block of T7-T11 dermatomes but is insufficient for midline incisions [6,7,13]. Nevertheless, procedures such as quadratus lumborum blocks, erector spina plane blocks, and thoracic epidural catheters, which give adequate analgesia in laparoscopic cholecystectomy operations, are among the regional anesthesia treatments that cannot be applied or are difficult to apply in the supine position [14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…They applied local anesthetic only to the lower surface of the chondrium in the patient who underwent laparotomy in the m-TAPA block and provided successful postoperative analgesia. TAPA and m-TAPA blocks were used in abdominal surgery and provided effective analgesia, according to the researchers [6,7]. Their studies with both blocks were carried out with a small number of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Thoracoabdominal nerves block through perichondrial approach (TAPA) and then modified-TAPA (m-TAPA) block, a modification of this block, have recently been described. It has been reported that TAPA block provides sensory block between the midaxillary line and the midabdominal/sternum in T5-T12 dermatomes, whereas m-TAPA block provides sensory block between the midaxillary line and the midabdominal/sternum in T8-T12 dermatomes [6,7]. In TAPA block, local anesthetic is applied to two points, the upper aspect of the chondrium and the lower aspect of the chondrium.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative analgesic efficacy of the thoracoabdominal nerves block through perichondrial approach (TAPA) and modified-TAPA for laparoscopic cholecystectomy: a randomized controlled study

2022

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Laparoscopic cholecystectomy is one of the most common surgical procedures. Even though there is less postoperative pain with laparoscopic cholecystectomy than with open cholecystectomy, severe pain can occur, particularly within the first 24 hours. Evaluation of the efficacy of ultrasound-guided interfascial plane blocks for postoperative analgesia of laparoscopic cholecystectomy has recently come to prominence. The aim of our study was to compare the postoperative analgesic efficacy of thoracoabdominal nerves block through perichondrial approach (TAPA) and modified-TAPA (m-TAPA) blocks in patients who underwent laparoscopic cholecystectomy. The present study included 56 patients who underwent laparoscopic cholecystectomy under general anesthesia and received TAPA or m-TAPA block for perioperative analgesia. Each patient signed a written informed consent form. Block times and numerical rating scale (NRS) scores 1, 2, 3, and 12 hours postoperatively, hourly and total tramadol amount of use via the patient-controlled analgesia device, and additional analgesic drug consumption were all recorded. The TAPA group had significantly longer block application times than the m-TAPA group. At 1 and 12 hours, NRS scores were lower in the TAPA group. However, the mean NRS scores, total tramadol use, and use of additional analgesics were comparable between the groups. TAPA and m-TAPA block methods reduced NRS scores by alleviating pain after laparoscopic cholecystectomy procedures, thereby reducing the need for additional analgesics. Block times for TAPA were significantly longer than those for m-TAPA. However, both block applications were completed in a short period, smoothly and safely. The analgesic effect of TAPA block was more distinctive at 1 and 12 hours, and NRS scores were lower. However, we think that both block methods, when used under ultrasound guidance, will provide effective analgesia by supplementing the multimodal analgesia planned for laparoscopic cholecystectomy and other abdominal operations.

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“…Opioid analgesics is still the primary treatment for moderate-to-severe postsurgical pain despite new therapies and interventions [1][2][3]. Nonetheless, the excessive use of opioids frequently leads to poor postsurgical recovery [4,5].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Intraoperative Methadone Compared to Morphine on Postsurgical Pain: A Meta-Analysis of Randomized Controlled Trials

Kendall

Alves

Pence

et al. 2020

Anesthesiology Research and Practice

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Background and Objectives. Methadone is commonly used in chronic pain, but it is not frequently used as an intraoperative analgesic. Several randomized studies have compared intraoperative methadone to morphine regarding postsurgical analgesia, but they have generated conflicting results. The aim of this investigation was to compare the analgesic efficacy of intraoperative methadone to morphine in patients undergoing surgical procedures. Methods. We performed a quantitative systematic review of randomized controlled trials in PubMed, Embase, Cochrane Library, and Google Scholar electronic databases. Meta-analysis was performed using the random effects model, weighted mean differences (WMD), standard deviation, 95% confidence intervals, and sample size. Methodological quality was evaluated using Cochrane Collaboration’s tool. Results. Seven randomized controlled trials evaluating 337 patients across different surgical procedures were included. The aggregated effect of intraoperative methadone on postoperative opioid consumption did not reveal a significant effect, WMD (95% CI) of −0.51 (−1.79 to 0.76), (P=0.43) IV morphine equivalents. In contrast, the effect of methadone on postoperative pain demonstrated a significant effect in the postanesthesia care unit, WMD (95% CI) of −1.11 (−1.88 to −0.33), P=0.005, and at 24 hours, WMD (95% CI) of −1.35 (−2.03 to −0.67), P<0.001. Conclusions. The use of intraoperative methadone reduces postoperative pain when compared to morphine. In addition, the beneficial effect of methadone on postoperative pain is not attributable to an increase in postsurgical opioid consumption. Our results suggest that intraoperative methadone may be a viable strategy to reduce acute pain in surgical patients.

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Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides effective analgesia in abdominal surgery and is a choice for opioid sparing anesthesia

Cited by 45 publications

References 4 publications

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

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

Postoperative analgesic efficacy of the thoracoabdominal nerves block through perichondrial approach (TAPA) and modified-TAPA for laparoscopic cholecystectomy: a randomized controlled study

The Effect of Intraoperative Methadone Compared to Morphine on Postsurgical Pain: A Meta-Analysis of Randomized Controlled Trials

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