Evaluation of the efficacy of M-TAPA and EXORA block application for analgesia after laparoscopic cholecystectomy: a prospective, single-blind, observational study.

backgroundDifferent field block methods are used for analgesia following abdominal surgery. In this study, we evaluated the efficacy of a modified thoracoabdominal nerve block via the perichondrial approach (M-TAPA) and that of an external oblique and rectus abdominis plane (EXORA) block for anterolateral upper abdominal analgesia.

methodsThis study included 90 patients undergoing laparoscopic cholecystectomy. Patients were divided into three groups (n = 30 per group): a control group, which received intravenous patient-controlled analgesia (IV-PCA); an EXORA block group, which received an EXORA block with 0.25% bupivacaine + IV-PCA; and an M-TAPA block group, which received an M-TAPA with 0.25% bupivacaine + IV-PCA. The primary outcome was postoperative pain (at rest and on movement), evaluated using numerical rating scale (NRS) scores at 2, 4, 6, 12, and 24 h postoperatively. Secondary outcomes included tramadol use, the side effect profile, dermatomal spread, and additional analgesic use at 12 h and 24 h postoperatively.

resultsNRS scores as well as the mean tramadol consumption at 12 h and 24 h postoperatively were significantly lower in the EXORA and M-TAPA groups than in the control group (all P < 0.001). Sensory block was recorded in the lateral and anterior abdomen from T7 to T11 after both EXORA block and M-TAPA application.

conclusionsEXORA block and M-TAPA application provided similar levels of analgesia to the upper abdominal wall after laparoscopic cholecystectomy. Further data should be obtained from cadaveric and other types of studies.