Modified thoracoabdominal nerves block through perichondrial approach for laparoscopic cholecystectomy

Erten, Ela; Kara, Umut; Şimşek, Fatih; Öztaş, Muharrem; Süzer, Mehmet Anıl; Kamburoğlu, Hasan; Eşkin, Mehmet Burak; Şenkal, Serkan; Çoşar, Ahmet

doi:10.1590/1806-9282.20230962

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Original Article • Rev. Assoc. Med. Bras. 70 (3) • 2024 • https://doi.org/10.1590/1806-9282.20230962 copy

Modified thoracoabdominal nerves block through perichondrial approach for laparoscopic cholecystectomy

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

A new block, namely, modified thoracoabdominal nerves block through perichondrial approach, is administered below the costal cartilage. We sought to compare the analgesic efficacy of the modified thoracoabdominal nerves block through perichondrial approach block with local anesthetic infiltration at the port sites in an adult population who underwent laparoscopic cholecystectomy.

METHODS:

Patients who will undergo laparoscopic cholecystectomy were randomized to receive bilateral ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach blocks or local anesthetic infiltration at the port insertion sites. The primary outcome was the total amount of tramadol used in the first 12 h postoperatively. The secondary outcomes were total IV tramadol consumption for the first postoperative 24 h and visual analog scale scores.

RESULTS:

The modified thoracoabdominal nerves block through perichondrial approach group had significantly less tramadol use in the first 12 h postoperatively (p<0.001). The modified thoracoabdominal nerves block through perichondrial approach group's visual analog scale scores at rest (static) and with movement (dynamic) were significantly lower compared with the port infiltration group (p<0.05).

CONCLUSION:

Patients who received modified thoracoabdominal nerves block through perichondrial approach block had significantly less analgesic consumption and better pain scores than those who received port-site injections after laparoscopic cholecystectomy.

KEYWORDS:
Laparoscopic cholecystectomy; Nerve block; Postoperative pain; Anesthetics, local

Variable	M-TAPA group (n=31)	Port infiltration group (n=29)	Effect size^a a Effect size is calculated by dividing the absolute standardized test statistic z by the square root of the number of pairs (n=60). (95%^d d 95%CI was calculated. or 99%^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement. CI)	Corrected^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement. p-value
PACU VAS-R^* * Measured immediately after PACU arrival. p<0.05 is considered statistically significant.	2.45±1.72	4.27±2.46	-1.82^c c The mean difference was used instead of the effect size. (-2.91 to −0.73)^d d 95%CI was calculated.	0.001^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.
1st hour VAS-R	3.00 (2.00, 4.00)	4.00 (3.00, 6.00)	0.48 (0.000 to 0.000)^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	<0.001^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.
2nd hour VAS-R	2.00 (1.00, 3.00)	3.00 (2.00, 4.00)	0.34 (0.007 to −0.012)^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	0.009^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.
4th hour VAS-R	2.00 (1.00, 3.00)	2.00 (1.00, 4.00)	0.16 (0.195 to 0.216)^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	0.206^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.
8th hour VAS-R	2.00 (0.00, 2.00)	2.00 (1.00, 3.00)	0.24 (0.051 to −0.063)^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	0.057^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.
12th hour VAS-R	1.00 (0.00, 2.00)	2.00 (1.00, 3.50)	0.36 (0.003 to 0.006)^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	0.004^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.
24th hour VAS-R	1.00 (0.00, 1.00)	1.00 (1.00, 2.00)	0.44 (0.000 to −0.001)^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	0.001^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.
PACU VAS-M*	3.00 (2.00, 5.00)	5.00 (3.00, 6.50)	0.30 (0.013 to 0.020)^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	0.017^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.
1st hour VAS-M	3.00 (2.00, 4.00)	5.00 (4.00, 6.00)	0.48 (0.000 to 0.000)^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	<0.001^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.
2nd hour VAS-M	2.83±1.50	4.34±1.79	-1.50^c c The mean difference was used instead of the effect size. (-2.361 to 0.650)^d d 95%CI was calculated.	0.001
4th hour VAS-M	2.00 (1.00, 3.00)	3.00 (2.00, 5.00)	0.38 (0.002 to 0.005)^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	0.004^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.
8th hour VAS-M	2.00 (1.00, 3.00)	3.00 (2.00, 4.00)	0.34 (0.004 to 0.008)^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	0.006^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.
12th hour VAS-M	1.00 (0.00, 2.00)	3.00 (2.00, 5.00)	0.53 (0.000 to 0.000)^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	<0.001^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.
24th hour VAS-M	1.00 (1.00, 2.00)	2.00 (1.00, 3.00)	0.39 (0.001 to 0.004)^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	0.003^b b 99%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.
2nd hour tramadol consumptions (mg)	24.61±17.25	40.00±18.65	-15.38 (-25.59 to −5.17)^e e 95%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	0.004^a a Effect size is calculated by dividing the absolute standardized test statistic z by the square root of the number of pairs (n=60).
4th hour tramadol consumptions (mg)	42.30±22.85	84.16±31.74	-41.85 (-57.49 to −26.21)^e e 95%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	<0.001^a a Effect size is calculated by dividing the absolute standardized test statistic z by the square root of the number of pairs (n=60).
8th hour tramadol consumptions (mg)	56.92±30.82	125.83±54.20	-68.91 (-93.73 to −44.08)^e e 95%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	<0.001^a a Effect size is calculated by dividing the absolute standardized test statistic z by the square root of the number of pairs (n=60).
12th hour tramadol consumptions (mg)	73.84±42.99	169.16±73.42	-95.32 (-129.21 to −61.42)^e e 95%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	<0.001^a a Effect size is calculated by dividing the absolute standardized test statistic z by the square root of the number of pairs (n=60).
24th hour tramadol consumptions (mg)	86.15±59.53	200.00±85.26	-113.84 (-155.39 to −72.29)^e e 95%CI and corrected p-value were calculated by Bonferroni's correction for multiple testing of repeated measurement.	<0.001^a a Effect size is calculated by dividing the absolute standardized test statistic z by the square root of the number of pairs (n=60).
24th hour QoR-15 score	110.77±19.13	98.48±18.09	—	0.013
Rescue analgesic requirement (Yes:No)	1:30 (3.2%:96.8%)	12:17 (41.4%:58.6%)	—	<0.001
Postoperative complications (Yes:No)	12:19 (38.7%:61.3%)	19:10 (65.5%:34.5%)	—	0.038
Nausea/vomiting (Yes:No)	10:21 (32.3%:67.7%)	18:11 (62.1%:37.8%)	—	0.021

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[1] *Corresponding author: drelacaliskan@hotmail.com