Cholecystectomy is the most common abdominal surgical procedure in developed countries
Laparoscopic cholecystectomy is considered the gold standard surgical technique for
gallstones.
Several factors play a role in pain after laparoscopic cholecystectomy. This pain is complex
and generally considered to be visceral. These factors are include phrenic nerve irritation
caused by CO2 insufflation, abdominal distension, port incisions, the effect of gallbladder
removal and individual factors.
Regional analgesia has been widely accepted by both patients and treating physicians and has
become an important part of multimodal analgesia techniques. Transversus abdominis plane
(TAP) block has been shown to reduce postoperative pain like hysterectomy, cholecystectomy,
cesarean section and colorectal surgery.
Ultrasound (US)-guided Modified Thoracoabdominal Nerve Block Through Perichondrial Approach
(M-TAPA) is performed by applying local anesthetic only to the underside of the perichondral
surface. It provides effective analgesia in the anterior and lateral thoracoabdominal area.
M-TAPA is a good alternative for analgesia of the upper dermatome levels and lateral
abdominal region and may be an opioid-sparing strategy that provides better quality recovery
in patients undergoing laporoscopic surgery. M-TAPA provides analgesia at the T5-T11 level in
the abdomen. Sonoanatomy is easy to visualize and the spread of local anesthetic can be
easily seen with US guidance. Cephalo caudal spread of local anesthetic solution produces
analgesia in several dermatomes. There are studies investigating the efficacy of M-TAPA for
postoperative pain management in bariatric surgery in the literature.
Global recovery score (QoR) 15 is a sensitive, reliable and easy method to measure
postoperative recovery quality. This scale, which has become a promising tool for assessing
the quality of the recovery period, questions various aspects of recovery in 5 different
areas: pain, physical comfort, physical independence, psychological support and emotional
state. It may be an important scale to evaluate the outcome of changes in healthcare for
quality assurance purposes in perioperative clinical studies. For these reasons, the
"Standardized Endpoints in Perioperative Medicine" initiative and the European Society of
Anesthesia have recommended the use of the QoR-15 scale in clinical studies investigating
patient comfort and pain levels after surgery.
The aim of this study was to compare the efficacy of US-guided M-TAPA block and TAP for
postoperative analgesia management after cholecystectomy. The primary outcome is to compare
global recovery scores, the secondary outcome is to compare postoperative pain scores (NRS),
to evaluate postoperative rescue analgesic (opioid) use and side effects (allergic reaction,
nausea, vomiting) associated with opioid use in this study.