comparison of modified thoracoabdominal plane nerve block through perichondrial approach and subcostal transversus abdomens plane block for quality of post operative analgesia in patients undergoing laparoscopic cholecystectomy a randomised controlled trial

Now a days laparoscopic cholecystectomy is a procedure of choice in surgical treatment for

symptomatic cholelithiasis Recovery after laparoscopic cholecystectomy depends upon

several factors Such as abdominal pain nausea vomiting and fatigue Although post

operative pain after laparoscopic cholecystectomy mainly depends upon factors like

peritoneal stretching and diaphragmatic irritation caused by high intraabdominal pressure and

by carbon dioxide retention Nonetheless total abdominal pain following laparoscopic

cholecystectomy is having somatic and visceral components Therefore our aim should be

to reduce the somatic component of pain that is incisional pain after laparoscopic

cholecystectomy It has also been stated that laparoscopic cholecystectomy causes significant

postoperative pain in one third of post operative patients up to first 24 hours after surgery A

recent PROSPECT review reported that standard way to reduce postoperative pain after

laparoscopic cholecystectomy is preoperative or intraoperative use of paracetamol with

NSAID and port site Local anaesthetic infiltration with long acting local anaesthetic agent

and also suggests that there is no role of number of surgical port insertion recently

published review and meta-analysis suggest that subcostal transversus abdominis plane

TAP block is having greatest reduction in pain score at 12 hours postoperatively compared

with other regional analgesic techniques

Subcostal TAP block was first suggested by Hebbard et al. and it is proven to provide

adequate analgesia for upper and lower abdominal surgeries  However, pain from the

incision site for the right lateral port in the laparoscopic cholecystectomy may not be

covered because it cannot block the lateral cutaneous branches of the thoracoabdominal

nerves To compensate this shortcomings of subcostal TAP block, Tulgar et al. introduced a

newer regional analgesic technique called as modified thoracoabdominal nerve block

through the perichondral approach  M TAPA in 2019  In this technique local anesthetics

are administered only to the underside of the perichondrial surface of tenth rib It has been

found that this technique provides a sensory block between T5-T12 dermatomes This has

recently been used for postoperative analgesia in laparoscopic abdominal surgeries because it

is considered to provide effective analgesia in the anterior and lateral thoracoabdominal

wallsThere are limited literature comparing the efficacy of modified  thoracoabdominal nerve blocks M TAPA with

subcostal  transversus abdominis plane blocks STAP therefore further studies are required to conclude the efficacy between the two fascial plane block