Comparison of modified thoracoabdominal nerve block through perichondral approach (M-TAPA block) and trocar site local anesthetic infiltration for pain management in total laparoscopic hysterectomy: a randomized-controlled trial

Background: The Modified Thoracoabdominal Nerve Block Through Perichondral Approach (M-TAPA) is a recently introduced intervention that has demonstrated analgesic efficacy in abdominal surgeries. However, there have been limited studies evaluating its effectiveness in gynecological surgeries. This study aimed to compare the analgesic efficacy of M-TAPA with Local Anesthetic Infiltration (LAI) at port sites in patients undergoing Total Laparoscopic Hysterectomy (TLH). Methods: Sixty-three patients scheduled for TLH were randomized to receive either bilateral ultrasound-guided M-TAPA or LAI at port insertion sites. The primary outcome was to evaluate and compare the effect of the M-TAPA block and trocar site LAI on total tramadol consumption within the first 24 hours postoperatively. Results: The results indicated no significant differences in cumulative tramadol consumption between the two groups at any time point (p = 0.191). Additionally, the Numerical Rating Scale (NRS) scores at 24 hours postoperatively were similar between the M-TAPA and LAI groups (p > 0.05). Moreover, both groups demonstrated an equal rate of rescue analgesic usage (LAI group: 25%, n = 8; M-TAPA group: 25%, n = 8) (p = 0.941), and the incidence of postoperative complications was comparable between the groups (p > 0.05). Conclusions: In conclusion, the M-TAPA block demonstrated similar postoperative analgesic efficacy to port site local anesthetic injection in patients undergoing TLH. Clinical Trial Registration: The trial was registered on ClinicalTrials.gov (identifier: NCT06601413) and conducted in compliance with the CONSORT guidelines.

Nerve block; Hysterectomy; Pain management; Laparoscopic surgery; Ultrasonography

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