Evaluation of the efficacy of M-TAPA and EXORA block application for analgesia after laparoscopic cholecystectomy: a prospective, single-blind, observational study.

Abstract

Background: Different field block methods are used for analgesia following abdominal surgery. In this study, we evaluated the efficacy of a modified thoracoabdominal nerve block via the perichondrial approach (M-TAPA) and that of an external oblique and rectus abdominis plane (EXORA) block for anterolateral upper abdominal analgesia.

Methods: This study included 90 patients undergoing laparoscopic cholecystectomy. Patients were divided into three groups (n = 30 per group): a control group, which received intravenous patient-controlled analgesia (IV.PCA); an EXORA block group, which received an EXORA block with 0.25% bupivacaine + IV.PCA; and an M-TAPA block group, which received an M-TAPA with 0.25% bupivacaine + IV.PCA. The primary outcome was postoperative pain (at rest and on movement), evaluated using numerical rating scale (NRS) scores at 2-, 4-, 6-, 12-, and 24-h postoperatively. Secondary outcomes included tramadol use, the side effect profile, dermatomal spread, and additional analgesic use at 12-h and 24-h postoperatively.

Results: NRS scores as well as the mean tramadol consumption at 12-h and 24-h postoperatively were significantly lower in the EXORA and M-TAPA groups than in the control group (all P < 0.001). Sensory block was recorded in the lateral and anterior abdomen from T7 to T11 after both EXORA block and M-TAPA application.

Conclusions: EXORA block and M-TAPA application provided similar levels of analgesia to the upper abdominal wall after laparoscopic cholecystectomy. Further data should be obtained from cadaveric and other types of studies.