Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2023.05.001
Brazilian Journal of Anesthesiology
Original Investigation

Efficacy of modified thoracoabdominal nerve block through perichondrial approach following laparoscopic inguinal hernia repair surgery: a randomized controlled trial

Eficácia do bloqueio do nervo toracoabdominal modificado por meio de abordagem pericondrial após cirurgia laparoscópica de correção de hérnia inguinal: um ensaio clínico randomizado

Selcuk Alver, Bahadir Ciftci, Hande Güngör, Birzat Emre Gölboyu, Yasar Ozdenkaya, Haci Ahmet Alici, Serkan Tulgar

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Abstract

Background

Modified thoracoabdominal nerve block through perichondrial approach is a novel fascial plane block and provides abdominal analgesia by blocking thoracoabdominal nerves. Our primary aim was to evaluate the efficacy of M-TAPA on quality of recovery and pain scores in patients who underwent laparoscopic inguinal hernia repair surgery (Trans Abdominal Pre-Peritoneal approach ‒ TAPP).

Methods

Patients with American Society of Anesthesiologists (ASA) physical status I–II aged between 18 and 65 years scheduled for elective TAPP under general anesthesia were enrolled in the study. After intubation, the patients were randomized into two groups: M: M-TAPA group (n = 30) and the control group (n = 30). M-TAPA was performed with total 40 ml 0.25% bupivacaine in the M group. Surgical infiltration was performed in the control group. The primary outcome of the study was the global quality of recovery score, the secondary outcomes were pain scores, rescue analgesic demands, and adverse effects during the 24-h postoperative period.

Results

The global quality of recovery scores at 24 h were significantly higher in the M group (p < 0.001). There was a reduction in the median static and dynamic NRS for the first postoperative 8 h in the M group compared to the control group (p < 0.001). The need for rescue analgesia was significantly lower in the M group compared to the control group (13 patients vs. 24 respectively, p < 0.001). The incidence of side effects was significantly higher in the control group (p < 0.001).

Conclusion

In our study, M-TAPA increased patient recovery scores, and provided pain relief in patients who underwent TAPP.

Keywords

Acute pain; Laparoscopic surgery; Pain management; Regional anesthesia; Ultrasonography

Resumo

Introdução

O bloqueio modificado do nervo toracoabdominal por meio de abordagem pericondrial é um novo bloqueio do plano fascial e fornece analgesia abdominal ao bloquear os nervos toracoabdominais. Nosso objetivo principal foi avaliar a eficácia do M-TAPA na qualidade da recuperação e nos escores de dor em pacientes submetidos à cirurgia laparoscópica de correção de hérnia inguinal (abordagem Trans Abdominal Pré-Peritoneal - TAPP).

Métodos

Pacientes com estado físico I–II da Sociedade Americana de Anestesiologistas (ASA) com idade entre 18 e 65 anos agendados para TAPP eletivo sob anestesia geral foram incluídos no estudo. Após a intubação, os pacientes foram randomizados em dois grupos: M: grupo M-TAPA (n = 30) e grupo controle (n = 30). O M-TAPA foi realizado com um total de 40 ml de bupivacaína a 0,25% no grupo M. A infiltração cirúrgica foi realizada no grupo controle. O desfecho primário do estudo foi o escore global de qualidade de recuperação, os desfechos secundários foram escores de dor, demanda de analgésico de resgate e efeitos adversos durante o período pós-operatório de 24 horas.

Resultados

Os escores globais de qualidade de recuperação em 24 horas foram significativamente maiores no grupo M (p < 0,001). Houve redução na mediana da NRS estática e dinâmica nas primeiras 8 horas de pós-operatório no grupo M em comparação ao grupo controle (p < 0,001). A necessidade de analgesia de resgate foi significativamente menor no grupo M em comparação ao grupo controle (13 pacientes vs. 24 respectivamente, p < 0,001). A incidência de efeitos colaterais foi significativamente maior no grupo controle (p < 0,001).

Conclusão

Em nosso estudo, o M-TAPA aumentou os escores de recuperação dos pacientes e proporcionou alívio da dor nos pacientes submetidos ao TAPP.

Palavras-chave

Dor aguda; Cirurgia laparoscópica; Manejo da dor; Anestesia regional; ultrassonografia

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