Korean J Pain.  2023 Jul;36(3):382-391. 10.3344/kjp.23114.

Comparison of modified thoracoabdominal nerve block through perichondral approach and subcostal transversus abdominis plane block for pain management in laparoscopic cholecystectomy: a randomized-controlled trial

• Cho HY
• Hwang IE
• Lee M
• Kwon W
• Kim WH
• Lee HJ

• KMID: 2544249
• DOI: http://doi.org/10.3344/kjp.23114

Abstract

Background
The modified thoracoabdominal nerve block through the perichondral approach (M-TAPA) is a novel regional analgesic technique that can provide analgesia for both the lateral and anterior abdominal walls. This study aimed to compare the analgesic effect of M-TAPA with that of the subcostal transversus abdominis plane block (TAPB) in patients undergoing laparoscopic cholecystectomy (LC).
Methods
Sixty patients scheduled to undergo elective LC were randomly assigned to receive either M-TAPA or subcostal TAPB during anesthesia induction. The primary outcome was the maximum pain intensity during movement within the first 12 hours postoperatively, measured using an 11-point numeric rating scale (NRS). Secondary outcomes included changes in NRS scores during rest, coughing, and movement, which were assessed at 1, 2, 4, 6, and 12 hours postoperatively and immediately before discharge. Additionally, postoperative nausea and vomiting, and patient satisfaction were recorded as secondary outcomes.
Results
Data from 56 patients were analyzed, and no significant difference was observed in the primary outcome between the two groups (M-TAPA: 5.5 [interquartile range (IQR): 5–7] vs. subcostal TAPB: 5 [IQR: 4–7], median difference: 0, 95% confidence interval: –1 to 1, P = 0.580). Furthermore, no significant differences in secondary outcomes were observed between the two groups.
Conclusions
No significant difference was observed in the analgesic effect between the two techniques. Consequently, further research is necessary to compare the efficacy of M-TAPA with other well-established regional analgesic techniques.

Keyword

Acute Pain; Cholecystectomy, Laparoscopic; Laparoscopy; Nerve Block; Pain, Postoperative; Patient Satisfaction; Postoperative Complications; Ultrasonography

Figure

• 

  Fig. 1 Ultrasound images of subcostal transversus abdominis plane block (A) and modified thoracoabdominal nerve block through perichondral approach (B). The arrow represents the needle. CC: costal cartilage, LA: local anesthetics, RAM: rectus abdominal muscle, TAM: transversus abdominis muscle, IOM: internal oblique muscle.

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  Fig. 2 CONSORT diagram of the study. M-TAPA: modified thoracoabdominal nerve block through the perichondral approach, TAPB: transversus abdominis plane block.

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  Fig. 3 Comparison of maximum pain intensity during movement within the first 12 hours postoperatively between the two groups. The box plot represents the median and interquartile range of the NRS in the M-TAPA and subcostal TAPB groups during the study period. The upper whisker represents the maximum value, whereas the lower whisker represents the minimum value, excluding outliers. The scatter plot, indicated by round symbols, displays individual data points. M-TAPA: modified thoracoabdominal nerve block through the perichondral approach, NRS: numeric rating scale, TAPB: transverse abdominis plane block.

• 

  Fig. 4 Comparisons of pain intensity at rest between the two groups. The box plot represents median and interquartile range of the NRS in the M-TAPA and subcostal TAPB groups during the study period. The upper whisker represents the maximum value, whereas the lower whisker represents the minimum value, excluding outliers. The scatter plot, indicated by round symbols, displays individual data points. M-TAPA: modified thoracoabdominal nerve block through the perichondral approach, NRS: numeric rating scale, TAPB: transverse abdominis plane block.

• 

  Fig. 5 Comparisons of pain intensity during coughing between the two groups. The box plot represents the median and interquartile range of the NRS in the M-TAPA and subcostal TAPB groups during the study period. The upper whisker represents the maximum value, whereas the lower whisker represents the minimum value, excluding outliers. The scatter plot, indicated by round symbols, displays individual data points. The asterisk represents a significant difference between the two groups in the post-hoc analysis. M-TAPA: modified thoracoabdominal nerve block through the perichondral approach, NRS: numeric rating scale, TAPB: transverse abdominis plane block.

• 

  Fig. 6 Comparisons of pain intensity during movement between the two groups. The box plot represents the median and interquartile range of the NRS in the M-TAPA and subcostal TAPB groups during the study period. The upper whisker represents the maximum value, whereas the lower whisker represents the minimum value, excluding outliers. The scatter plot, indicated by round symbols, displays individual data points. M-TAPA: modified thoracoabdominal nerve block through the perichondral approach, NRS: numeric rating scale, TAPB: transverse abdominis plane block.

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