405: Bilateral M-TAPA As A Post Laparoscopic Cholecystectomy Analgesia

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Acute postsurgical pain, Treatment/management

Background and Aims: Laparoscopic cholecystectomy (LC) is a less invasive procedure and offers benefits compared with open surgeries. Even if LC is a minimally invasive, patients may experience a severe pain, postoperatively following surgery. One of the PROSPECT guideline recommendation is providing analgesia using a regional anaesthesia technique which is represented by the Th6-Th10 Thoracoabdominal nerve block as they play major roles in an acute pain following LC surgery. The Bilateral Modified Thoracoabdominal Nerve Block Through Perichondrial Approach (M-TAPA) represents valid alternatives to achieve this objective, as it provides wide dermatomal blockade in the anterior and lateral abdomen between the Th6-Th7 and Th12-L1 levels. This technique is easy to perform, and there is no difficulties or major potential complications were reported. We described a three serial case of patients who underwent LC surgery and have received USG guided bilateral M-TAPA as the postoperative analgesia.

Methods: Three patients with ASA status II, aged between 30 and 55 years have undergone elective LC surgery by a standard three-port laparoscopic technique under general anesthesia and received bilateral M-TAPA under USG guidance using a high-frequency linear probe (6-13 MHz). The probe was positioned at level of the ninth and tenth ribs on the costal cartilage in the sagittal plane. A 25 mL of 0.25% Levobupivacaine with adjuvant 5 mg of Dexamethasone for each side was injected through a 20-G spinal needle in-plane approach into the plane between IOM and TAM at lower surface of the tenth costal cartilage.

Results: We evaluated NRS score at 1,2,4,8,12,18, and 24 h postoperatively, side effects, and additional rescue analgesia usage. During observation, all patients have significantly tolerable NRS score (1-3) at rest and movement and has no any additional analgesic rescue given during the first 24 hours postoperatively other than their regular analgesic. The incidence of postoperative nausea and vomiting along with other complication related to M-TAPA procedure were not recorded.

Conclusions: The bilateral USG-guided M-TAPA technique is a relatively new regional anesthesia technique designed to provide postoperative analgesia after abdominal surgeries. However, it can be considered as an effective option in addition to the multimodal analgesia of patient who undergo laparoscopic cholecystectomy, as it has a wide dermatomal analgesia coverage. This block is relatively easy to perform, associated with a low complication rate, and clinically proved to reduce postoperative pain score, the need of rescue analgesia and opioid consumptions postoperatively.

References: 1. Okmen K, Yildiz DK, Ulker GK. Evaluation of the efficacy of M-TAPA and EXORA block application for analgesia after Laparoscopic cholecystectomy: a prospective, single-blind, observational study. Korean J ANesthesiol. 2025; 78(4): 361-368. doi:10.4097/kja.24563
2. Bilge A, Başaran B, 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;22: 329: 1-9. doi: 10.1186/s12871-022-01866-4
3. Erten E, Kara U, Şimşek F, Öztaş M, Süzer MA, et al. Modified thoracoabdominal nerves block through perichondrial approach for laparoscopic cholecystectomy. Rev Assoc Med Bras. 2024;70(3):e20230962. doi: 10.1590/1806-9282.20230962
4. Ciftci B, Alver S, Gölboyu BE, Cassai A, Tulgar S, et al. AComparison of TwoFascial Plane Blocks for Abdominal Analgesia in Laparoscopic Cholecystectomy Surgery (M-TAPA vs. External Oblique Intercostal Plane Block): A Prospective Randomized Study. J. Clin. Med. 2025, 14, 3050 . doi: 10.3390/jcm14093050
5. Şehirlioğlu S, Moralar DG, Ozakin O, Aydemir T, Ergul F. Anterior Quadratus lumborum block versus modified perichondrial thoracoabdominal nerve block (m-TAPA) for postoperative analgesia following laparoscopic cholecystectomy: a randomized controlled trial. BMC Anesthesiology (2025) 25:393:1-11. doi: 10.1186/s12871-025-03281-x
6. 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 J Anesthesiol 2022;75(4):357-359. doi: 10.4097/kja.22137
7. Cho HY, Hwang IE, Lee M, Kwon W, Kim WH, et al. Comparison of modified thoracoabdominal nerve block through perichondral approach and subcostal transversus abdominis plane block for pain management in laparoscopic cholecystectomy: a randomized-controlled trial. Korean J Pain 2023;36(3):382-391. doi: 10.3344/kjp.23114
8. Ökmen K, Yıldız DK, Ülker GK. Evaluation of the efficacy of M-TAPA and EXORA block application for analgesia after laparoscopic cholecystectomy: a prospective, single-blind, observational study. Korean J Anesthesiol 2025;78(4):361-368. doi: 10.4097/kja.24563
9. Tanaka N, Ida M, Suzuka T, Kawaguchi M. Modified thoracoabdominal nerves block through perichondrial approach for surgical patients: a scoping review. BMC Anesthesiology. 2024; 24:478. doi: 10.1186/s12871-024-02878-y
10. Bilge A, Başaran B, Et T, Korkusuz M, Yarımoğlu R, 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; 22:329. doi: 10.1186/s12871-022-01866-4
11. Avci O, Gundogdu O, Balci F, Tekcan MN. Effects of Modified Thoracoabdominal Nerve Block Through Perichondrial Approach on Postoperative Pain and Analgaesic Consumption in Patients Undergoing Laparoscopic Cholecystectomy. . J Coll Physicians Surg Pak 2024; 34(01):5-10. doi: 10.29271/jcpsp.2024.01.5
12. Park I, Park JH, Koo CH, Kim JH, Ryu JH, et al. Modified Thoracoabdominal Nerves Block Through Perichondral Approach: A Systematic Review and Meta-analysis. Journal of PeriAnesthesia Nursing 40. 2025: 205–212. doi: 10.1016/j.jopan.2024.03.014
13. ERTÜRK T, ERSOY A. Postoperative analgesic efficacy of the thoracoabdominal nerves block through perichondrial approach (TAPA) and modified-TAPA for laparoscopic cholecystectomy: a randomized controlled study. Signa Vitae 2022 vol.18(2), 114-120. doi: 10.22514/sv.2022.004
14. Bilge A, Başaran B, Altıparmak B, Tayfun Et, Korkusuz M, et al. Comparing ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach with oblique subcostal transversus abdominis plane block for patients undergoing laparoscopic cholecystectomy: a randomized, controlled trial. BMC Anesthesiology. 2023;23:139. doi: 10.1186/s12871-023-02106-z
15. Elhoshy HS, Khalifa AF. Modified thoracoabdominal nerves block through perichondrial approach: a new strategy with a wide range of utilization in laparoscopic gynecological surgeries. Research and Opinion in Anesthesia & Intensive Care. 2024, 11:278–286. doi:10.4103/roaic.roaic_39_24
16. Gola W, Zając M, Cugowsk A. Adjuvants in peripheral nerve blocks – the current state of knowledge. Anaesthesiol Intensive Ther. 2020;52(4):323-329. doi: 10.5114/ait.2020.98213
17. Zufferey1 PJ, Chaux R, Lachaud PA, Capdevila X, Lanoiselee, et al. Dose response relationships of intravenous and perineural dexamethasone as adjuvants to peripheral nerve blocks: a systematic review and model-based network meta-analysis. British Journal of Anaesthesia, 2024; 132 (5): 1122e1132. doi: 0.1016/j.bja.2023.12.021

Presenting Author: Gusti Ayu Pitria Septiani
Submitting Author: Gusti Ayu Pitria Septiani

Senior Author: Arief Rachman Setiawan

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Arief Rachman Setiawan: Medical doctor, anesthesiologist - Hasanuddin University Hospital, Makassar, Indonesia