Outcomes of Thoracoabdominal Nerve Block Through Perichondrial Approach* on Postoperative Cognitive Functions
Condition: Pain, Postoperative; Cognition
MeSH terms: Pain, Postoperative
Study type: Observational

Summary: 
      It was planned to compare the opioid consumption and cognitive functions in the postoperative
      period of patients who received TAPA block for postoperative analgesia and patients who did
      not prefer the block and who preferred intravenous patient-controlled analgesia (PCA) with
      opioids. Both the surgery applied and the drugs used in anesthesia can cause changes in
      cognitive functions by affecting the inflammatory process. It is thought that if the
      patients' pain can be relieved sufficiently in the postoperative period with TAPA block, the
      consumption of opioids used will be less and their cognitive functions will be less affected.
    

Detailed description: 
      Postoperative pain management after major surgical operations is a very important issue.
      Features such as waking up without pain, early recovery from anesthesia, not suppressing
      respiration by the drugs used for postoperative pain treatment, not delaying recovery from
      anesthesia, not having unwanted side effects, and not delaying discharge from the intensive
      care unit are the desired features of postoperative pain management. A wide variety of drug
      therapy modalities are available for this purpose. However, peripheral nerve blocks are
      widely used to minimize undesirable effects of drug therapy. TAP block (trans abdominal plane
      block) has been used for this purpose since ancient times. TAPA block (thoracoabdominal block
      with perichondral approach) is a newly developed plane block and was developed to obtain
      higher level block with a single injection. In this study, we planned to compare the recovery
      times from anesthesia, postoperative pain scores, opioid consumption, and cognitive functions
      of patients who underwent TAPA block for postoperative pain treatment and patients who were
      not preferred to TAPA block and were planned for pain treatment with conventional methods,
      whether these treatments affected or not.

      Neuropsychological dysfunction is a frequently encountered condition after surgery.
      Postoperative cognitive dysfunction can affect various cognitive functions such as attention,
      memory, and information processing speed. The most notable symptoms are memory deficits and
      decreased ability to cope with intellectual difficulties. It has been stated that
      postoperative cognitive dysfunction depends on advanced age, duration of anesthesia,
      development of complications, pre-existing cognitive disorders, and education level.

      In a study, it was reported that the incidence of postoperative cognitive dysfunction in
      patients aged around 60 years who underwent major noncardiac surgery was 25.8% after 1 week
      and 9.9% after 3 months.

      In the literature, it has been mentioned that inflammatory processes that occur as a result
      of surgical trauma and subsequent complications play a role in cognitive dysfunction. Normal
      cognitive functions can be maintained in low-level inflammatory processes, while very
      high-level proinflammatory factors can significantly affect cognitive functions.

      Traditional lateral TAP block is performed on the midaxillary line between the iliac crest
      and subcostal. With this approach, with cadaveric dye injection, T11 was shown to be
      maintained and T12 was maintained 100% time, L1 93% time and T10 50% time. The lateral TAP
      block reached a dermatome high enough to benefit the patient after open cholecystectomy.

      The TAPA block is performed at the rib margin where the 9th and 10th ribs meet. A linear
      transducer is placed at the costochondral angle in the sagittal plane. It is carried out by
      injecting 20 ml of drug between the upper and lower surface of the chondrium. The authors
      state that TAPA block provides analgesia to T5-T12. They hypothesize that the TAPA block
      numbs both the lateral cutaneous branch and the anterior region.

      Although the standardized mini-mental test is not a definitive diagnostic test, it is used by
      clinicians as an auxiliary test to measure the degree of cognitive deterioration of patients.

      We planned this study to compare the recovery times from anesthesia, postoperative pain
      scores, opioid consumption, and cognitive functions of patients who underwent TAPA block for
      postoperative pain management and patients who were not preferred TAPA block and were planned
      for pain treatment with conventional methods, whether these treatments were affected or not.
    

Intervention name(s): Group I: TAPA block; Group II: IV Morphine
Intervention type(s): Procedure; Procedure
Intervention description(s): Postoperative analgesia will be provided with peripheral nerve block (TAPA); Postoperative analgesia will be provided with opioids
Other intervention name(s): thoracoabdominal block perichondral appearance; intravenous morphine group
Intervention MeSH terms: Morphine
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        The patients who will undergo major abdominoplasty, ASA II and ASA III, over the age of 18,
        under the age of 85 in the Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research
        Hospital.
      
Keywords: TAPA block, opioid consumption, cognitive functions