COMPARISION OF MODIFIED THORACOABDOMINAL NERVE BLOCK THROUGH PERICHONDRAL APPROACH AND SUBCOSTAL TRANSVERSE ABDOMINIS PLANE BLOCK FOR PAIN MANAGEMENT IN LAPAROSCOPIC CHOLECYSTECTOMY

Abstract

Background: Laparoscopic cholecystectomy is associated with postoperative pain arising from somatic, visceral, and referred components, which may delay recovery and increase opioid consumption. Ultrasound-guided fascial plane blocks have become an integral component of multimodal analgesia. The modified thoracoabdominal nerve block through the perichondral approach (M-TAPA) is a novel regional anaesthetic technique that may provide broader thoracoabdominal nerve blockade and superior postoperative analgesia compared with the conventional ultrasound guided subcostal transversus abdominis plane (TAP) block. Materials and Methods: This prospective comparative study included 150 adult patients (ASA physical status I–II) undergoing elective laparoscopic cholecystectomy under general anaesthesia. Patients were allocated into two equal groups: Group A received the M-TAPA block (n=75), while Group B received the ultrasound-guided subcostal TAP block (n=75). Postoperative pain at rest and during movement was assessed using the Numerical Rating Scale (NRS) at 1, 2, 4, 6, and 12 hours and before discharge. Total postoperative opioid consumption, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), patient satisfaction, and block-related complications were compared between the groups. Results: Baseline demographic and perioperative characteristics were comparable between the two groups (p>0.05). Patients receiving the M-TAPA block demonstrated significantly lower postoperative pain scores at rest and during movement at all postoperative time points compared with the subcostal TAP block (p<0.001). Total opioid consumption was significantly lower in the M-TAPA group (74.20 ± 20.50 mg vs. 106.64 ± 24.10 mg; p<0.001), while the time to first rescue analgesia was significantly prolonged (392.50 ± 85.20 minutes vs. 279.60 ± 78.40 minutes; p<0.001). Although postoperative nausea and vomiting was less frequent (40.0% vs. 60.0%) and patient satisfaction was higher (50.7% vs. 41.3%) in the M-TAPA group, these differences were not statistically significant (p>0.05). No significant block-related complications were observed. Conclusion: The modified thoracoabdominal nerve block through the perichondral approach provided significantly superior postoperative analgesia compared with the ultrasound-guided subcostal TAP block following laparoscopic cholecystectomy. It effectively reduced postoperative pain intensity, decreased opioid consumption, and prolonged the duration of analgesia while maintaining an excellent safety profile. M-TAPA may therefore be considered a valuable opioid-sparing component of multimodal analgesia for patients undergoing laparoscopic cholecystectomy.