Comparison of modified thoracoabdominal nerve block (MTAPA) vs external oblique plane block (EOI) in patients undergoing laparoscopic cholecystectomy: A prospective randomized controlled trial.

This single center prospective randomized clinical trial is being conducted at the department of anaesthesiology aiims nagpur to compare the postoperative analgesic efficacy of ultrasound guided modified thoracoabdominal nerves block through perichondrial approach mtapa and external oblique intercostal eoi block in patients undergoing elective laparoscopic cholecystectomy. Despite laparoscopic cholecystectomy being a minimally invasive procedure postoperative pain remains a significant concern attributed to incisional visceral and peritoneal pain mechanisms. Multimodal analgesia including regional anesthesia techniques has emerged as a key strategy in postoperative pain control.This study hypothesizes that the mtapa block by targeting thoracoabdominal nerves from T4 to T12 dermatomes will offer superior analgesic outcomes and reduce opioid consumption compared to the eoi block which targets the lateral and anterior cutaneous branches of intercostal nerves T6 to T11. Seventy adult patients aged 18 to 65 years and classified as asa physical status I and II will be randomized into two groups of 34 each. Both blocks will be performed using ultrasound guidance by a trained anesthesiologist while postoperative pain scores and opioid consumption will be assessed by a blinded observer.

Primary outcome is total opioid consumption within 24 hours postoperatively. Secondary outcomes include intraoperative and postoperative hemodynamic stability, pain scores atvarious time intervals using the numerical rating scale and assessment of recovery using a questionnaire. Any adverse effects such as nausea vomiting or bradycardia will also be recorded. Data will be statistically analyzed using a statistical software. This study aims to provide evidence on the comparative efficacy of mtapa and eoi blocks in enhancing postoperative recovery and analgesia potentially guiding future anesthesia protocols for laparoscopic surgeries.