M-Tapa Block vs External Oblique Intercostal Block for Laparoscopic Sleeve Gastrectomy Surgery
Condition: Anesthesia; Regional Anesthesia; Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      In obese patients, adequate pain relief in the postoperative period is an important parameter
      that affects patient comfort and hospital stay. Increasing patient comfort and recovery
      quality can be achieved by avoiding undesirable effects such as nausea, vomiting, and
      analgesia. This study aimed to investigate the effects of Bilateral External Oblique
      Intercostal Block (EOIB) and Perichondrial Modified Thoracoabdominal Nerve Block (M-TAPA) on
      postoperative acute pain scores (0-24 hours) and 24-hour opioid consumption in patients who
      underwent laparoscopic sleeve gastrectomy.
    

Detailed description: 
      Morbid obesity patients often have multisystem physiological changes and multiple
      comorbidities that can significantly affect perioperative pain control. These patients may
      have increased side effects from inadequate acute pain management and opioids should be used
      with caution.

      Regional techniques can be applied in obese patients because they provide non-opioid
      analgesia and have fewer perioperative respiratory side effects. Effective pain control is
      associated with reduced post-operative opioid administration, faster mobilization, faster
      recovery, and shorter hospital stay.

      Intraoperative nerve blocks using local anesthetics have been shown to improve postoperative
      pain in various abdominal surgeries, both open and laparoscopic. Recently, it has been
      reported that the M-TAPA block is a promising new technique that provides effective analgesia
      of the anterior and lateral thoracoabdominal walls during laparoscopic surgery, in which
      local anesthetic is delivered only to the underside of the perichondral surface.

      TAPA/M-TAPA block has been shown to provide a potent analgesic effect in a large abdomen by
      numbing both the anterior and lateral cutaneous branches of the thoracoabdominal nerves.
      Therefore, the TAPA/M-TAPA block has been used in various abdominal surgeries. The EOI block
      represents an important modification of the fascial plane block techniques that can
      consistently cover the upper lateral abdominal wall.

      When we look at the literature, it is seen that there are not enough studies on M-TAPA block
      and EOIB.

      The aim of this study is to investigate the effects of Bilateral External Oblique Intercostal
      Block (EOIB) and Perichondrial Modified Thoracoabdominal Nerve Block (M-TAPA) on
      postoperative acute pain scores (0-24 hours) and 24-hour opioid consumption in patients who
      underwent laparoscopic sleeve gastrectomy. Our study, which the investigators think will
      contribute to the literature, was planned as a prospective, randomized, controlled,
      parallel-group study.

      Patients will be divided into two groups:

      Group M-TAPA :

      A bilateral M-TAPA (60 ml 0.25% bupivacaine + 1:400.000 adrenaline) will be performed. In
      addition, IV morphine-PCA will be applied postoperatively for 24 hours.

      Group EOIB :

      A bilateral EOIB (60 ml 0.25% bupivacaine + 1:400.000 adrenaline) will be performed. In
      addition, IV morphine-PCA will be applied postoperatively for 24 hours.
    

Intervention name(s): Bilateral ultrasound guided external oblique intercostal block (EOIB); Bilateral ultrasound guided Modified thoracoabdominal nerves block through perichondrial approach(M-TAPA) block; IV morphine patient-controlled analgesia (PCA)
Intervention type(s): Procedure; Procedure; Drug
Intervention description(s): Bilateral ultrasound-guided EOIB (total of 60 ml, %0.25 bupivacaine) will be performed + IV morphine PCA Multimodal analgesia : Patients are administered iv tenoxicam 20mg and tramadol 100 mg after induction of general anesthesia, and iv paracetamol 1 gr and 0.05 mg/kg, ideal body weight (IBW), iv morphine will be administered. End of the surgery, hyoscine-N-butyl bromide will be administered. Postoperative analgesia: iv paracetamol 1gr every 8 hours and IV PCA of 0,5 mg/ml morphine (the bolus dose is 20 μg/kg, the lock-in time of 6-10 minutes, the 4-hour limit is adjusted to be 80% of the calculated total amount). In cases where rescue analgesia is required (NRS score ≥4), 50 mg of meperidine is administered to patients.
Patients are routinely administered ondansetron 8 mg IV 20 minutes before extubation for postoperative nausea and vomiting prophylaxis.; Bilateral ultrasound guided Modified thoracoabdominal nerves block through perichondrial approach(M-TAPA) block (total of 60 ml, %0.25 bupivacaine) will be performed + IV morphine PCA Multimodal analgesia : Patients are administered iv tenoxicam 20mg and tramadol 100 mg after induction of general anesthesia, and iv paracetamol 1 gr and 0.05 mg/kg, ideal body weight (IBW), iv morphine will be administered. End of the surgery, hyoscine-N-butyl bromide will be administered. Postoperative analgesia: iv paracetamol 1gr every 8 hours and IV PCA of 0,5 mg/ml morphine (the bolus dose is 20 μg/kg, the lock-in time of 6-10 minutes, the 4-hour limit is adjusted to be 80% of the calculated total amount). In cases where rescue analgesia is required (NRS score ≥4), 50 mg of meperidine is administered to patients.
Patients are routinely administered ondansetron 8 mg IV 20 minutes before extubation for postoperative nausea and vomiting prophylaxis.; Morphine will be administered via PCA device for the first 24 hours after surgery
Other intervention name(s): External oblique intercostal block (EOIB); M-TAPA block; morphine PCA
Intervention MeSH terms: Morphine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A block randomization list will be created by a doctor who does not participate in patient follow-up using a web-based program.
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Anesthesia; Nerve block; Sleeve gastrectomy; External oblique intercostal block