USG-guided M-TAPA vs OSTAP Block in Patients Undergoing Laparoscopic Cholecystectomy
Condition: Laparoscopic Cholecystectomy
Study type: Interventional

Summary: 
      In this study, the postoperative analgesic effect of ultrasound-guided modified
      thoracoabdominal nerves blocks through perichondrial approach (M-TAPA) and oblique subcostal
      transversus abdominis plane block(OSTAP) will be searched in patients recruiting for
      laparoscopic cholecystectomy (LC) and the two groups will be compared in terms postoperative
      opioid consumption.

      The primary aim of this study is to compare the effects of ultrasound-guided (M-TAPA) and
      OSTAP blocks on opioid consumption after LC surgery. It is hypothesized that M-TAPA will
      reduce opioid consumption of the patients more than the OSTAP block.
    

Detailed description: 
      Laparoscopy is a minimally invasive procedure, but postoperative pain is still the most
      common symptom after laparoscopic cholecystectomy (LC).

      Oblique subcostal transversus abdominis plane (OSTAP) block is a regional anesthesia
      technique defined for abdominal surgeries. Previously, several studies have reported that
      ultrasound-guided OSTAP blocks reduce postoperative pain scores after LC. M-TAPA block is
      performed by applying local anesthetic to the lower surface of the chondrium. This technique
      provides effective analgesia in the abdominal wall.

      This study will be conducted as a single-center, prospective, randomized, double-blinded
      trial in a university hospital. Patients scheduled for elective laparoscopic cholecystectomy
      will be screened for enrollment in the study. After randomization, M-TAPA and OSTAP blocks
      will be performed under ultrasound guidance after administering general anesthesia and prior
      to the skin incision. An anesthesiologist who performed blocks will not involve in the data
      collection. Other health care workers who will involve in the evaluation of postoperative
      pain scores, vital parameters, nausea and vomiting, antiemetic, opioid consumption, and
      Quality of Recovery score will be blinded to group assignment.
    

Intervention name(s): M-TAPA block; OSTAP block
Intervention type(s): Procedure; Procedure
Intervention description(s): After tracheal intubation, a high-frequency linear probe will be placed in the sagittal direction at the 10th costal margin, and transversus abdominis, internal oblique, and external oblique muscles will be identified. A block needle will be inserted with in-plane technique and 25 ml 0.25% bupivacaine will be injected between the transversus abdominis muscle and the lower aspect of the costal cartilage. The same procedure will be repeated on the contralateral side.
Standard perioperative and postoperative multimodal analgesia The pain intensity during rest and motion will be evaluated with the 0-10 Numeric Rating Scale (NRS). Patients will receive standard multimodal analgesia comprising paracetamol, dexketoprofen, and tramadol.; The patients will receive oblique subcostal TAP block in the supine position immediately after the endotracheal intubation. The anesthesiologist of the operating room will place the ultrasound with a linear probe subcostally and from the xiphoid to the right iliac crest obliquely. Rectus abdominis muscle and underlying transversus abdominis muscle, will be identified near the costal margin. The needle will be directed to the transversus abdominis fascia. Local anesthetic solution of 25 ml 0.25% will be injected to between rectus abdominis and transversus abdominis muscles along the oblique subcostal line. The same procedure will repeated to the contralateral side.
Standard perioperative and postoperative multimodal analgesia The pain intensity during rest and motion will be evaluated with the 0-10 Numeric Rating Scale (NRS). Patients will receive standard multimodal analgesia comprising paracetamol, dexketoprofen, and tramadol.
Other intervention name(s): Global Quality of Recovery-15 score; Standard Pain Follow up and Monitorization; Global Quality of Recovery-15 score; Standard Pain Follow up and Monitorization
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Parallel Assignment Allocation: Randomized Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: modified-thoracoabdominal nerves block; oblique subcostal transversus abdominis plane block; postoperative pain