M-Tapa vs OSTAP for Laparoscopic Inguinal Hernia Repair Surgery
Condition: Inguinal Hernia
MeSH terms: Hernia; Hernia, Inguinal
Study type: Interventional

Summary: 
      Inguinal hernia repair is the most common of abdominal surgical procedures and is usually
      performed laparoscopically. Many factors play a role in the pain that develops after surgery
      and is generally considered to be visceral pain. Phrenic nerve irritation due to CO2
      insufflation into the peritoneal cavity, abdominal distention, tissue trauma, sociocultural
      status, and individual factors are the factors that play a role in the occurrence of this
      pain.

      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
      thoracoabdominal areas, where 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 abdominal lateral wall and may be an opioid-sparing strategy with satisfactory
      quality recovery in patients undergoing laparoscopic surgery.

      Oblique Subcostal Transversus Abdominis Plane Block (OSTAP) is one of the body blocks used
      especially for postoperative analgesia. OSTAP, defined by Hebbard in 2010, is a subcostal
      version of the Transversus abdominis plane block (TAP block), based on the injection of local
      anesthetic from the lower edge of the costal margin, obliquely between the obliquus externus
      and Transversus abdominis muscles.

      This study aimed to compare the efficacy of US-guided M-TAPA block and OSTAP block for
      postoperative analgesia management after laparoscopic inguinal hernia repair surgery. Our
      primary aim is to compare postoperative pain scores (0. hour NRS), and our secondary aim is
      to evaluate the use of rescue analgesics (opioids), side effects associated with opioid use
      (allergic reaction, nausea, vomiting), and patient satisfaction (Likert scale).
    

Detailed description: 
      Inguinal hernia repair is the most common of abdominal surgical procedures and is usually
      performed laparoscopically. Many factors play a role in the pain that develops after surgery
      and is generally considered to be visceral pain. Phrenic nerve irritation due to CO2
      insufflation into the peritoneal cavity, abdominal distention, tissue trauma, sociocultural
      status, and individual factors are the factors that play a role in the occurrence of this
      pain.

      Postoperative pain is acute pain accompanied by an inflammatory process due to surgical
      trauma and gradually decreases with tissue healing. Postoperative pain 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 being unable 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
      thoracoabdominal areas, where 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 that provides a
      satisfactory quality improvement in patients undergoing laparoscopic surgery. M-TAPA block
      provides analgesia in the abdominal region at the T5-T11 level. Sonoanatomy is easy to
      visualize and the spread of local anesthetic can be easily seen under US guidance. With the
      cephalocaudal 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 postoperative pain management in bariatric surgery.

      Oblique Subcostal Transversus Abdominis Plane Block (OSTAP) is one of the body blocks used
      especially for postoperative analgesia. OSTAP, which Hebbard defined in 2010, is a subcostal
      version of the Transversus abdominis plane block (TAP block) and is based on the injection of
      local anesthetic from the lower edge of the costal margin, obliquely between the obliquus
      externus and Transversus abdominis muscles. OSTAP; Although it is frequently used in
      laparoscopic abdominal surgery, it is a very difficult block to implement. There are studies
      reporting that it provides successful analgesia after various abdominal surgeries.

      This study aimed to compare the efficacy of US-guided M-TAPA block and OSTAP block for
      postoperative analgesia management after laparoscopic inguinal hernia repair surgery. Our
      primary aim is to compare postoperative pain scores (0. hour NRS), and our secondary aim is
      to evaluate the use of rescue analgesics (opioids), the side effects associated with opioid
      use (allergic reaction, nausea, vomiting), and patient satisfaction (Likert scale).
    

Intervention name(s): Postoperative management
Intervention type(s): Drug
Intervention description(s): Patients will be administered ibuprofen 400 mgr IV every 8 hours in the postoperative period. Postoperative patient evaluation will be performed by a pain nurse blinded to the procedure. 100 mg tramadol will be performed for rescue analgesia.
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 inguinal hernia repair surgery will be included in the study. Patients will be randomly divided into two groups (Group M TAPA = M-TAPA group, Group OSTAP = OSTAP group) including 30 patients each, before entering the operating room.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Laparoscopic inguinal hernia repair; Postoperative pain management; Modified Perichondral Approach Thoracoabdominal Nerve (M-TAPA) block; Oblique Subcostal Transversus Abdominis Plane Block