M-Tapa Block vs External Oblique Intercostal Block for Laparoscopic Cholesistectomy
Condition: Cholecystitis; Cholecystitis, Acute
MeSH terms: Cholecystitis; Acalculous Cholecystitis; Cholecystitis, Acute
Study type: Interventional

Summary: 
      Ultrasound (US)-guided Modified Perichondral Approach Thoracoabdominal Nerve (M-TAPA) block
      is a novel block that provides effective analgesia in the anterior and lateral abdominal
      walls after laparoscopic surgery, and local anesthetic is applied only to the lower side of
      the perichondral surface. M-TAPA block is a good alternative for analgesia of the upper
      dermatome levels and the abdominal lateral wall and may be an opioid-sparing strategy with
      good quality recovery in patients undergoing laparoscopic surgery.

      US-guided External oblique intercostal block (EOB) is a block performed by injection of local
      anesthetic between the external and internal oblique muscles. This block provides abdominal
      analgesia between T6-T10 levels. There are studies in the literature showing that it provides
      effective analgesia. However, there is no study comparing M-TAPA and EOB yet.

      In this study, our aim is to compare the effectiveness of US-guided M-TAPA block and EOB for
      postoperative analgesia management after laparoscopic cholecystectomy surgery. Our primary
      aim is to compare patient recovery scores (QoR15 Turkish version), our secondary aim is to
      compare postoperative pain scores (24-hour NRS), postoperative rescue analgesic use (opioid),
      and opioid-related side effects (allergic reaction, nausea, vomiting).
    

Detailed description: 
      Cholecystectomy is the most common of the abdominal surgical procedures performed in
      developed countries and is usually performed laparoscopically. Many factors play a role in
      the pain that develops after laparoscopic cholecystectomy and is generally considered to be
      visceral pain. Phrenic nerve irritation as a result of CO2 insufflation into the peritoneal
      cavity, abdominal distention, tissue trauma, trauma due to the removal of the gallbladder,
      sociocultural status, and individual factors are the factors that play a role in the
      emergence of this pain.

      Postoperative pain is acute pain that is accompanied by an inflammatory process due to
      surgical trauma and gradually decreases with tissue healing. Postoperative pain in patients
      undergoing laparoscopic cholecystectomy is a serious problem that reduces patient comfort and
      delays the patient's return to work after surgery. Successful postoperative analgesia, occurs
      in the patient due to pain; It is a known fact that it prevents many of the effects such as
      not being able to breathe easily and delayed mobilization.

      Modified Perichondral Approach Thoracoabdominal Nerve (M-TAPA) block performed with
      ultrasound (US) is a new block that provides effective analgesia in the anterior and lateral
      abdominal walls after laparoscopic surgery in which local anesthetic is applied only to the
      lower side of the perichondral surface. M-TAPA block is a good alternative for analgesia of
      the upper dermatome levels and the abdominal lateral wall and may be an opioid-sparing
      strategy with good quality recovery in patients undergoing laparoscopic surgery.

      M-TAPA block provides analgesia in the T5-T11 abdominal region. Sonoanatomy is easy to
      visualize on US and the spread of local anesthetic can be easily seen. With the
      cephalo-caudal spread of the local anesthetic solution, analgesia occurs in several
      dermatomes. In the literature, there are studies investigating the effectiveness of M-TAPA
      block for post-operative pain management in bariatric surgery. In the literature, there is no
      randomized study evaluating the effectiveness of M-TAPA block for postoperative analgesia
      management after laparoscopic cholecystectomy operation.

      US-guided External oblique intercostal block (EOB) is a block performed by injection of local
      anesthetic between the external and internal oblique muscles. This block provides abdominal
      analgesia between T6-T10 levels. There are studies in the literature showing that it provides
      effective analgesia. However, there is no study comparing M-TAPA and EOB yet.
    

Intervention name(s): M-TAPA; EOB
Intervention type(s): Drug; Drug
Intervention description(s): Under aseptic conditions, a high-frequency linear probe will be placed on the costochondral angle in the sagittal plane. Then the probe will be slightly angled deeply to visualize the lower view of the perichondrium. We will perform M-TAPA with total of 40 ml (20 ml for each side) of %0,25 bupivacaine.; In the supine position, a high-frequency linear US probe (11-12 MHz, Vivid Q) will be covered with a sterile sheath, and an 80 mm block needle (Braun 360°) will be used. The US probe will be placed on the midaxillary line between the spina iliaca anterior superior and the umbilicus. Using the In-Plane technique, 5 ml of saline will be injected under the external oblique muscle of the block needle and the block location will be confirmed. After the block location is confirmed, 20 ml of 0.25% bupivacaine will be administered. The same procedure will be applied to the other side (40 ml of 0.25% bupivacaine in total).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Sixty patients aged 18-65 years old with American Society of Anesthesiologists (ASA) classification I-II and scheduled for laparoscopic cholesistectomy surgery will be included in the study. Patients will be randomly divided into two groups (Group M = M-TAPA group, Group EOB = EOB group) including 30 patients each, before entering the operating room.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Laparoscopic Cholesistectomy; Postoperative pain management; M-TAPA block; External oblique intercostal block