Title
Author
DOI
Article Type
Special Issue
Volume
Issue
Modified thoracoabdominal nerve block through perichondrial approach for laparoscopic appendectomy in children: a randomized trial
1Department of Anesthesiology and Reanimation, Gulhane Training and Research Hospital, 06010 Ankara, Turkey
2Department of Pediatric Surgery, Gulhane Training and Research Hospital, 06010 Ankara, Turkey
3Department of Anesthesiology and Reanimation, Etlik City Hospital, 06010 Ankara, Turkey
4Department of Education, Gulhane Training and Research Hospital, 06010 Ankara, Turkey
DOI: 10.22514/sv.2024.093 Vol.20,Issue 10,October 2024 pp.89-96
Submitted: 31 January 2024 Accepted: 17 April 2024
Published: 08 October 2024
*Corresponding Author(s): Ela Erten E-mail: ela.erten@saglik.gov.tr
The modified thoracoabdominal nerve block through perichondrial approach (M-TAPA), an interfascial plane block, effectively induces analgesia in the anterior and lateral thoracoabdominal walls and has demonstrated efficacy in adult patients. However, its application in the pediatric population remains unexplored. This investigation aims to assess the efficacy of M-TAPA in children undergoing laparoscopic appendectomy. Sixty pediatric patients undergoing laparoscopic appendectomy under general anesthesia were enrolled in this single-center study. Preoperatively, the participants were randomly assigned to receive either port-site local anesthetic infiltration or M-TAPA. The primary outcome measure was the numeric rating scale (NRS) pain score assessed 6 hours postoperatively. Secondary outcomes included NRS pain scores at various time intervals, requirement for rescue analgesia, time to first request for rescue analgesics, and incidences of postoperative complications such as nausea, vomiting and shoulder tip pain. The results revealed significantly lower NRS scores in the M-TAPA group compared to the local anesthetic infiltration group, except at the 24-hour mark post-laparoscopic appendectomy (p < 0.05). Additionally, the local anesthetic infiltration group exhibited a higher rate of rescue analgesic usage (53.3%, n = 16) compared to the M-TAPA group (13.3%, n = 4) (p = 0.001). Although the incidences of nausea, vomiting and shoulder pain were elevated in the local anesthetic infiltration group relative to the M-TAPA group, these differences did not reach statistical significance (p > 0.05). In conclusion, M-TAPA demonstrates superior efficacy in postoperative analgesia compared to port-site local anesthetic injection in pediatric laparoscopic appendectomies.
Pediatrics; Appendectomy; Ultrasonography; Nerve block; Local anesthetics; Postoperative pain
Ela Erten,Gokhan Berktug Bahadır,Umut Kara,Fatih Simsek,Huseyin Emre Atasever,Seyyid Furkan Kına,Yasemin Ozkan. Modified thoracoabdominal nerve block through perichondrial approach for laparoscopic appendectomy in children: a randomized trial. Signa Vitae. 2024. 20(10);89-96.
[1] Liu Y, Seipel C, Lopez ME, Nuchtern JG, Brandt ML, Fallon SC, et al. A retrospective study of multimodal analgesic treatment after laparoscopic appendectomy in children. Pediatric Anesthesia. 2013; 23: 1187–1192.
[2] Baird R, Ingelmo P, Wei A, Meghani Y, Perez EV, Pelletier H, et al. Nebulized analgesia during laparoscopic appendectomy (NALA): a randomized triple-blind placebo controlled trial. Journal of Pediatric Surgery. 2019; 54: 33–38.
[3] Nagappa S, Nanjundaswamy N, Maralusiddappa V, Nayak V. Comparing the intraoperative and postoperative analgesic effect of transabdominal block versus caudal block in children undergoing laparoscopic appendectomy. The Indian Anaesthetists Forum. 2022; 23: 19.
[4] Sandeman DJ, Bennett M, Dilley AV, Perczuk A, Lim S, Kelly KJ. Ultrasound-guided transversus abdominis plane blocks for laparoscopic appendicectomy in children: a prospective randomized trial. British Journal of Anaesthesia. 2011; 106: 882–886.
[5] Goyal R, Powell Francis W. Anaesthesia for paediatric laparoscopic surgery. Paediatric Anaesthesia. 2020; 1–6.
[6] Tulgar S, Selvi O, Thomas Dt, Deveci U, Özer Z. Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides effective analgesia in abdominal surgery and is a choice for opioid sparing anesthesia. Journal of Clinical Anesthesia. 2019; 55: 109.
[7] Güngör H, Ciftci B, Alver S, Gölboyu Be, Ozdenkaya Y, Tulgar S. Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) vs local infiltration for pain management after laparoscopic cholecystectomy surgery: a randomized study. Journal of Anesthesia. 2023; 2: 254–260.
[8] Alver S, Ciftci B, Güngör H, Gölboyu Be, Ozdenkaya Y, Alici Ha, et al. Efficacy of modified thoracoabdominal nerve block through perichondrial approach following laparoscopic inguinal hernia repair surgery: a randomized controlled trial. Brazilian Journal of Anesthesiology. 2023; 5: 595–602.
[9] Thalayasingam P, Weber D. Acute pain management in children. In Sims C, Weber D, Johnson C (eds). A Guide to Pediatric Anesthesia (pp. 199–220). 2nd edn. Springer: Cham, Switzerland. 2020.
[10] Wu H, Leung S. Can Likert scale be treated as interval scales?—A simulation study. Journal of Social Service Research. 2017; 4: 527–532.
[11] Faul F, Erdfelder E, Lang A, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 2007; 39: 175–191.
[12] Kaszyński M, Lewandowska D, Sawicki P, Wojcieszak P, Pągowska-Klimek I. Efficacy of intravenous lidocaine infusions for pain relief in children undergoing laparoscopic appendectomy: a randomized controlled trial. BMC Anesthesiology. 2021; 21: 2.
[13] Nelson R, Shimon T, Grimsby GM. Pediatric urologic surgery: reducing opioid use. Pediatric Drugs. 2021; 23: 417–423.
[14] Flack SH, Martin LD, Walker BJ, Bosenberg AT, Helmers LD, Goldin AB, et al. Ultrasound‐guided rectus sheath block or wound infiltration in children: a randomized blinded study of analgesia and bupivacaine absorption. Pediatric Anesthesia. 2014; 24: 968–973.
[15] Bilge A, Başaran B, Et T, Korkusuz M, Yarımoğlu R, Toprak H, et al. Ultrasound-guided bilateral modified-thoracoabdominal nerve block through a perichondrial approach (M-TAPA) in patients undergoing laparoscopic cholecystectomy: a randomized double-blind controlled trial. BMC Anesthesiology. 2022; 1: 329.
[16] Ohgoshi Y, Kawagoe I, Ando A, Ikegami M, Hanai S, Ichimura K. Novel external oblique muscle plane block for blockade of the lateral abdominal wall: a pilot study on volunteers. Canadian Journal of Anaesthesia. 2022; 10: 1203–1210.
[17] Chin KJ, McDonnell JG, Carvalho B, Sharkey A, Pawa A, Gadsden J. Essentials of our current understanding. Regional Anesthesia and Pain Medicine. 2017; 42: 133–183.
[18] Ciftci B, Alici HA, Ansen G, Sakul BU, Tulgar S. Cadaveric investigation of the spread of the thoracoabdominal nerve block using the perichondral and modified perichondral approaches. Korean Journal of Anesthesiology. 2022; 75: 357–359.
[19] Ozen V, Acik ME, Ozen N. The modified thoracoabdominal nerve block for post-operative analgesia in paediatric laparoscopic cholecystectomy. To be published in Journal of Minimal Access Surgery. 2023. [Preprint].
[20] Singh K, Kumar A, Sinha A, Kandrakonda P. Ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach for subcostal incision in a pediatric patient. Saudi Journal of Anaesthesia. 2022; 16: 516.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 1.3 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.
Top