Efficacy of modified thoracoabdominal nerve block through perichondrial approach following laparoscopic inguinal hernia repair surgery: a randomized controlled trial
Eficácia do bloqueio do nervo toracoabdominal modificado por meio de abordagem pericondrial após cirurgia laparoscópica de correção de hérnia inguinal: um ensaio clínico randomizado
Selcuk Alver, Bahadir Ciftci, Hande Güngör, Birzat Emre Gölboyu, Yasar Ozdenkaya, Haci Ahmet Alici, Serkan Tulgar
Abstract
Background
Modified thoracoabdominal nerve block through perichondrial approach is a novel fascial plane block and provides abdominal analgesia by blocking thoracoabdominal nerves. Our primary aim was to evaluate the efficacy of M-TAPA on quality of recovery and pain scores in patients who underwent laparoscopic inguinal hernia repair surgery (Trans Abdominal Pre-Peritoneal approach ‒ TAPP).
Methods
Patients with American Society of Anesthesiologists (ASA) physical status I–II aged between 18 and 65 years scheduled for elective TAPP under general anesthesia were enrolled in the study. After intubation, the patients were randomized into two groups: M: M-TAPA group (n = 30) and the control group (n = 30). M-TAPA was performed with total 40 ml 0.25% bupivacaine in the M group. Surgical infiltration was performed in the control group. The primary outcome of the study was the global quality of recovery score, the secondary outcomes were pain scores, rescue analgesic demands, and adverse effects during the 24-h postoperative period.
Results
The global quality of recovery scores at 24 h were significantly higher in the M group (p < 0.001). There was a reduction in the median static and dynamic NRS for the first postoperative 8 h in the M group compared to the control group (p < 0.001). The need for rescue analgesia was significantly lower in the M group compared to the control group (13 patients vs. 24 respectively, p < 0.001). The incidence of side effects was significantly higher in the control group (p < 0.001).
Conclusion
In our study, M-TAPA increased patient recovery scores, and provided pain relief in patients who underwent TAPP.
Keywords
Resumo
Introdução
O bloqueio modificado do nervo toracoabdominal por meio de abordagem pericondrial é um novo bloqueio do plano fascial e fornece analgesia abdominal ao bloquear os nervos toracoabdominais. Nosso objetivo principal foi avaliar a eficácia do M-TAPA na qualidade da recuperação e nos escores de dor em pacientes submetidos à cirurgia laparoscópica de correção de hérnia inguinal (abordagem Trans Abdominal Pré-Peritoneal - TAPP).
Métodos
Pacientes com estado físico I–II da Sociedade Americana de Anestesiologistas (ASA) com idade entre 18 e 65 anos agendados para TAPP eletivo sob anestesia geral foram incluídos no estudo. Após a intubação, os pacientes foram randomizados em dois grupos: M: grupo M-TAPA (n = 30) e grupo controle (n = 30). O M-TAPA foi realizado com um total de 40 ml de bupivacaína a 0,25% no grupo M. A infiltração cirúrgica foi realizada no grupo controle. O desfecho primário do estudo foi o escore global de qualidade de recuperação, os desfechos secundários foram escores de dor, demanda de analgésico de resgate e efeitos adversos durante o período pós-operatório de 24 horas.
Resultados
Os escores globais de qualidade de recuperação em 24 horas foram significativamente maiores no grupo M (p < 0,001). Houve redução na mediana da NRS estática e dinâmica nas primeiras 8 horas de pós-operatório no grupo M em comparação ao grupo controle (p < 0,001). A necessidade de analgesia de resgate foi significativamente menor no grupo M em comparação ao grupo controle (13 pacientes vs. 24 respectivamente, p < 0,001). A incidência de efeitos colaterais foi significativamente maior no grupo controle (p < 0,001).
Conclusão
Em nosso estudo, o M-TAPA aumentou os escores de recuperação dos pacientes e proporcionou alívio da dor nos pacientes submetidos ao TAPP.
Palavras-chave
References
1. Elsharkawy H, El-Boghdadly K. Barrington M. Quadratus Lumborum Block: Anatomical Concepts, Mechanisms, and Techniques. Anesthesiology. 2019;130:322−35.
2. Tsai HC, Yoshida T, Chuang TY, et al. Transversus Abdominis Plane Block: An Updated Review of Anatomy and Techniques. Biomed Res Int. 2017;2017:8284363.
3. Tulgar S, Senturk O, Selvi O, et al. Perichondral approach for blockage of thoracoabdominal nerves: Anatomical basis and clinical experience in three cases. J Clin Anesth. 2019;54:8−10.
4. Tulgar S, Selvi O, Thomas DT, Deveci U, Ozer Z. Modi € fied thoracoabdominal nerves block through perichondrial approach (MTAPA) provides effective analgesia in abdominal surgery and is a choice for opioid sparing anesthesia. J Clin Anesth. 2019;55:109.
5. Ciftci B, Alici HA, Ansen G, Sakul BU, Tulgar S. Cadaveric investigation of the spread of the thoracoabdominal nerve block using the perichondral and modified perichondral approaches. Korean J Anesthesiol. 2022;75(4):357−9.
6. Aikawa K, Yokota I, Maeda Y, Morimoto Y. Evaluation of sensory loss obtained by modified-thoracoabdominal nerves block through perichondrial approach in patients undergoing gynecological laparoscopic surgery: a prospective observational study. Reg Anesth Pain Med. 2022;7(2):134−5.
7. Ohgoshi Y, Ando A, Kawamata N, Kubo EN. Continuous modified thoracoabdominal nerves block through perichondrial approach (MTAPA) for major abdominal surgery. J Clin Anesth. 2020;60:45−6.
8. de Oliveira EJSG, De Lima RC, Sakata RK, et al. Modified Thoracoabdominal Nerve Block Through the Perichondral Approach (M-TAPA) in Laparoscopic Sleeve Gastroplasty: A Case Series. Obes Surg. 2022;32(1):197−201.
9. Aikawa K, Tanaka N, Morimoto Y. Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides a sufficient postoperative analgesia for laparoscopic sleeve gastrectomy. J Clin Anesth. 2020;59:44−5.
10. Alt{parmak B, Korkmaz Toker M, Uysal A_ I, Turan M, Gum€ u€s Demirbi- ¸ lek S. The successful usage of modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) for analgesia of laparoscopic ventral hernia repair. J Clin Anesth. 2019;57:1−2.
11. Lopez-Gonz alez JM, L opez- Alvarez S, Jim enez G omez BM, Arean Gonz alez I, Illodo Miramontes G, Padín Barreiro L. Ultra- sound-guided transversalis fascia plane block versus anterior transversus abdominis plane block in outpatient inguinal hernia repair. Rev Esp Anestesiol Reanim. 2016;63:498−504.
12. Oti C, Mahendran M, Sabir N. Anaesthesia for laparoscopic surgery. Br J Hosp Med (Lond). 2016;77:24−8.
13. Henny CP, Hofland J. Laparoscopic surgery: pitfalls due to anesthesia, positioning, and pneumoperitoneum. Surg Endosc. 2005;19:1163−71.
14. Sakamoto B, Harker G, Eppstein AC, Gwirtz K. Efficacy of local anesthetic with dexamethasone on the quality of recovery following total extraperitoneal bilateral inguinal hernia repair: a randomized clinical trial. JAMA Surg. 2016;151(12):1108−14.
15. Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017;152:292−8. 601
16. Simpson JC, Bao X, Agarwala A. Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols. Clin Colon Rectal Surg. 2019;32:121−8.
17. Myles PS, Weitkamp B, Jones K, Melick J, Hensen S. Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth. 2000;84:11−5.
18. Gornall BF, Myles PS, Smith CL, et al. Measurement of quality of recovery using the QoR-40: a quantitative systematic review. Br J Anaesth. 2013;111:161−9.
19. Altıparmak B, Korkmaz Toker M, Uysal AI, Dere O, U € gur B. Evaluation of ultrasound-guided rhomboid intercostal nerve block for postoperative analgesia in breast cancer surgery: a prospective, randomized controlled trial. Reg Anesth Pain Med. 2020;45: 277−82.
20. Yao Y, Li J, Hu H, Xu T, Chen Y. Ultrasound-guided serratus plane block enhances pain relief and quality of recovery after breast cancer surgery: A randomised controlled trial. Eur J Anaesthesiol. 2019;36:436−41.
21. Rozen WM, Tran TM, Ashton MW, Barrington MJ, Ivanusic JJ, Taylor GI. Refining the course of the thoracolumbar nerves: a new understanding of the innervation of the anterior abdominal wall. Clin Anat. 2008;21:325−33.
22. Tulgar S, Ahiskalioglu A, De Cassai A, Gurkan Y. Efficacy of bilateral erector spinae plane block in the management of pain: current insights. J Pain Res. 2019;12:2597−613.
23. Zinboonyahgoon N, Luksanapruksa P, Piyaselakul S, et al. The ultrasound-guided proximal intercostal block: anatomical study and clinical correlation to analgesia for breast surgery. BMC Anesthesiol. 2019;19:94.
24. Black ND, Stecco C, Chan VWS. Fascial Plane Blocks: More Questions Than Answers? Anesth Analg. 2021;132(3):899−905.
25. Bilge A, Basaran B, Et T, et al. Ultrasound-guided bilateral mod- ¸ ified-thoracoabdominal nerve block through a perichondrial approach (M-TAPA) in patients undergoing laparoscopic cholecystectomy: a randomized double-blind controlled trial. BMC Anesthesiol. 2022;22:329.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email