Modified Thoracoabdominal Nerve Block Through Perichondrial Approach (M-TAPA) in Major Abdominal Surgeries
Condition: Abdominal Surgery
Study type: Interventional

Summary: 
      This study will be conducted to evaluate efficacy of ultrasound guided modified
      thoracoabdominal nerves block via a new perichondrial approach (M-TAPA) for postoperative
      analgesia in major abdominal surgeries in comparison to subcostal transverse abdominis plane
      (SCTAP) block.

      It is hypothesized that M-TAPA block will be advantageous to SCTAP block as a promising
      effective alternative for analgesia for major abdominal surgeries with fewer side effects.
    

Detailed description: 
      Postoperative pain management for major abdominal surgeries can reduce postoperative
      respiratory dysfunction and promote early mobilization. Traditionally, opioids have been used
      to manage postoperative pain. However, an increasing awareness of opioid-related adverse
      events including respiratory depression, paralytic ileus, and sedation, has led to a shift
      towards utilizing opioid-sparing techniques for postoperative analgesia. As such, outcomes
      associated with the transverse abdominis plane block are of increasing interest. A modified
      thoracoabdominal nerves block via a new perichondrial approach (M-TAPA) is a novel analgesic
      technique that involves local anesthetic injection into the lower aspect of the chondrium. It
      can block thoracoabdominal nerves at T5 in cephalic direction and down to T11-T12 in caudal
      direction and may be an effective analgesic for major abdominal surgeries.

      The aim of this study is to assess the quality of pain relief in patients who will undergo
      major abdominal surgery receiving either (M-TAPA) block or (SCTAP) block by comparing and
      evaluating the differences between the two techniques.

      This prospective, randomized, comparative clinical study will include 80 patients who will be
      scheduled for major abdominal surgery under general anesthesia in Mansoura university
      hospitals. Informed written consent will be obtained from all subjects in the study after
      ensuring confidentiality. Eligible patients will be randomly assigned to 2 equal groups
      (M-TAPA group and SCTAP group) according to computer-generated table of random numbers using
      the permuted block randomization method. The collected data will be coded, processed, and
      analyzed using SPSS program. All data will be considered statistically significant if P value
      is ≤ 0.05.
    

Intervention name(s): M-TAPA block; SCTAP block; Bupivacaine Hydrochloride
Intervention type(s): Procedure; Procedure; Drug
Intervention description(s): A high-frequency linear ultrasound probe will be used, probe will be placed on the costochondral angle in the sagittal plane and angled deeply to view the lower aspect of the chondrium in the midline, then using in-plane approach, a 22 Gauge Tuohy needle will be introduced into the lower aspect of the chondrium. The same procedure will be repeated on the contralateral side.; A high-frequency linear ultrasound probe will be placed obliquely on the upper abdominal wall, along the subcostal margin near the midline. After identifying the rectus abdominis muscle, the ultrasound probe will be gradually moved laterally along the subcostal margin until the transversus abdominis muscle will be identified lying posterior to the rectus muscle, then using in-plane approach, a 22 Gauge Tuohy needle will be introduced medially and directed towards the transversus abdominis plane until its tip reaches the fascia between the rectus abdominis and the transverse abdominis muscles on entering the neurofascial plane. The same procedure will be repeated on the contralateral side.; 20 ml 0.25% bupivacaine will be injected after the negative aspiration test.
Other intervention name(s): Ultrasound guided block; Ultrasound guided block; Marcaine
Intervention MeSH terms: Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Thoracoabdominal nerve block