397: A systematic review of M-TAPA for laparoscopic abdominal surgeries

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

Background and Aims: Modified thoracoabdominal nerve block (M-TAPA) is a novel block for the anterolateral branches of thoracoabdominal nerves. M-TAPA offer extensive analgesic coverage, typically from thoracic segments T5–T12 and T7–T12, respectively. This study aims to investigate the effectiveness of ultrasound-guided Modified Thoracoabdominal nerve block through the Perichondral Approach (M-TAPA) for analgesia in laparoscopic abdominal surgeries. This systematic review of M-TAPA was conducted to comprehensively assess current clinical evidence, identify knowledge gaps, and explore implications for future research. The insights gained from this review will be instrumental in refining clinical guidelines and enhancing the utilisation of M-TAPA in perioperative pain management.

Methods: Databases PubMed, Scopus, Embase, and Web of Science were searched to identify relevant studies comparing M-TAPA with other pain management strategies, such as intravenous opioid analgesics, surgical infiltration of local anaesthetic at the port site, or other interventional blocks. We included randomised controlled trials that included patients undergoing laparoscopic abdominal surgery. Numerical Rating Scale (NRS), Analgesia and Quality of recovery were recorded.
This systematic review was registered in PROSPERO under registration number CRD420251047638. The study adhered to PRISMA (Preferred Reporting Items for Systematic Reviews) guidelines.

Results: MTAPA was compared with various analgesic modalities like local anaesthetic infiltration, regional blocks, and intravenous analgesia in the eleven studies. MTAPA consistently outperformed local infiltration and intravenous analgesia in reducing postoperative pain scores and analgesic consumption, while showing comparable efficacy to other regional techniques: External Oblique Intercostal (EOI), Oblique Subcostal Transversus Abdominis Plane block (OSTAPB), Serratus Anterior Plane Block(STAPB), Thoracoabdominal plane block through perichondral approach (TAPA), and Quadratus Lumborum Block (QLB).

Conclusions: M-TAPA demonstrated significantly greater analgesic efficacy than most other interventions. This systematic review provides evidence supporting M-TAPA as a superior option for postoperative pain management, patient-reported pain outcomes, and quality of recovery (QoR). Future research should focus on standardising procedural protocols, such as needle tip placement and the expected spread of local anaesthetic, to advance the clinical application of M-TAPA. More comparative studies with established regional interventions will be valuable in determining relative efficacy. Additionally, identifying the optimal volume and concentration of local anaesthetics will be essential to maximise analgesic effectiveness, patient safety, and QoR.

References: 1. Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy. British Journal of Surgery. 2000 Mar;87(3):273-84.
2. Elsharkawy H, Maniker R, Bolash R, Kalasbail P, Drake RL, Elkassabany N. Rhomboid intercostal and subserratus plane block: a cadaveric and clinical evaluation. Regional Anaesthesia & Pain Medicine. 2018 Oct 1;43(7):745-51.
3. Altıparmak B, Toker MK, Uysal AI, Kuşçu Y, Demirbilek SG. Ultrasound-guided erector spinae plane block versus oblique subcostal transversus abdominis plane block for postoperative analgesia of adult patients undergoing laparoscopic cholecystectomy: Randomised, controlled trial. Journal of clinical anesthesia. 2019 Nov 1;57:31-6
4. Tulgar S, Senturk O, Selvi O, Balaban O, Ahiskalioğlu A, Thomas DT, Ozer Z. Perichondral approach for blockage of thoracoabdominal nerves: anatomical basis and clinical experience in three cases. Journal of clinical anesthesia. 2019;54:8-10.
5. Park I, Park JH, Koo CH, Kim JH, Koo BW, Ryu JH, et al. Modified Thoracoabdominal Nerves Block Through Perichondral Approach: A Systematic Review and Meta-analysis. J Perianesth Nurs . 2025 Feb 1;40(1):205–12.
6. E Erten E, Kara U, Şimşek F, Öztaş M, Süzer MA, Kamburoğlu H, Eşkin MB, Şenkal S, Çoşar A. Modified thoracoabdominal nerves block through perichondrial approach for laparoscopic cholecystectomy. Revista da Associação Médica Brasileira. 2024 Apr 22;70(3):e20230962.
7. Avci O, Gundogdu O, Balci F, Tekcan M. Effects of Modified Thoracoabdominal Nerve Block Through Perichondrial Approach on Postoperative Pain and Analgesic Consumption in Patients Undergoing Laparoscopic Cholecystectomy. JCPSP-J Coll PHYSICIANS Surg Pak. 2024 Jan;34(1):5–10.
8. 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 randomised study. Journal of Anaesthesia. 2023 Apr;37(2):254-60.
9. Alver S, Ciftci B, Güngör H, Gölboyu BE, Ozdenkaya Y, Alici HA, Tulgar S. Efficacy of modified thoracoabdominal nerve block through perichondrial approach following laparoscopic inguinal hernia repair surgery: a randomised controlled trial. Brazilian Journal of Anesthesiology. 2023 Oct 23;73(5):595-602.
10. Turunc E, Dost B, Sarikaya Ozel E, Kaya C, Ustun YB, Bilgin S, Ozbalci GS, Koksal E. Bilateral Ultrasound-Guided External Oblique Intercostal Block Vs. Modified Thoracoabdominal Nerve Block Through Perichondrial Approach for Postoperative Analgesia in Patients Undergoing Laparoscopic Sleeve Gastrectomy Surgery: A Randomised Controlled Study. Obesity Surgery. 2024 Oct;34(10):3726-34.
11.Ciftci B, Alver S, Gölboyu BE, Haksal MC, Tulgar S, De Cassai A, Alici HA. A Comparison of Two Fascial Plane Blocks for Abdominal Analgesia in Laparoscopic Cholecystectomy Surgery (M-TAPA vs. External Oblique Intercostal Plane Block): A Prospective Randomised Study. Journal of Clinical Medicine. 2025 Apr 28;14(9):3050.
12. Suzuka T, Tanaka N, Kadoya Y, Ida M, Iwata M, Ozu N, Kawaguchi M. Comparison of Quality of Recovery between Modified Thoracoabdominal Nerve Block through Perichondrial Approach versus Oblique Subcostal Transversus Abdominis Plane Block in Patients Undergoing Total Laparoscopic Hysterectomy: a Pilot Randomised Controlled Trial. Journal of Clinical Medicine. 2024 Jan 25;13(3):712.
13. Bilge A, Başaran B, Altıparmak B, Et T, Korkusuz M, Yarımoğlu R. Comparing ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach with oblique subcostal transversus abdominis plane block for patients undergoing laparoscopic cholecystectomy: a randomised, controlled trial. BMC Anesthesiology. 2023 Apr 27;23(1):139.
14. Cho HY, Hwang IE, Lee M, Kwon W, Kim WH, Lee HJ. 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. The Korean Journal of Pain. 2023 Jul 1;36(3):382-91.
15. 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 Mar 1;18(2):114-20.
16.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 randomised controlled trial. BMC Anesthesiol. 2025 Aug 4;25(1):393.
17.Baytar Ç, Gürbüz Z, Köksal İncegül BG, Baytar MS, Taşdöven İ, Pişkin Ö. Effects of Modified Thoracoabdominal Nerves Block Through Pericondrial Approach on Postoperative Pulmonary Functions in Laparoscopic Bariatric Surgery: A Randomised Controlled Study. Obesity Surgery. 2025 May 21:1-0.
18. Bilge A, Başaran B, Et T, Korkusuz M, Yarımoğlu R, Toprak H, Kumru N. 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 Oct 28;22(1):329.
19. Wan M, Dong J, Wei K, Jin J, Cao J, Yuan B. Ultrasound-guided modified thoracoabdominal nerve block for postoperative analgesia in laparoscopic renal cyst decompression: a randomized double-blind controlled trial—frontiers in Medicine. 2025 Jul 4;12:1582428.
20. Myles PS, Weitkamp B, Jones K, Melick J, Hensen S. Validity and reliability of a postoperative quality of recovery score: the QoR-40. British journal of anaesthesia. 2000 Jan 1;84(1):11-5.
21. Ciftci B, Alver S, Gölboyu BE, Haksal MC, Tulgar S, De Cassai A, Alici HA. A Comparison of Two Fascial Plane Blocks for Abdominal Analgesia in Laparoscopic Cholecystectomy Surgery (M-TAPA vs. External Oblique Intercostal Plane Block): A Prospective Randomised Study. Journal of Clinical Medicine. 2025 Apr 28;14(9):3050.
22. Nakahari H, Takahashi T, Miki H, Yamaguchi A. Postoperative Analgesia With Modified Thoracoabdominal Nerve Block Through Perichondrial Approach in Neonatal and Infantile Abdominal Surgery. Cureus. 2024 Jul 23;16(7).
23. Ohgoshi Y, Ando A, Kawamata N, Kubo EN. Continuous modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) for major abdominal surgery. Journal of Clinical Anaesthesia. 2019 Aug 20;60:45-6.
24. Altıparmak B, Uysal Aİ, Turan M, Gümüş Demirbilek S. The successful usage of modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) for analgesia of laparoscopic ventral hernia repair. Journal of Clinical Anaesthesia. 2019 Mar 1;57:1-2.
25. Et T, Korkusuz M. Modified thoracoabdominal perichondrial approach (M-TAPA) injections with bupivacaine and dexamethasone on treatment of postherpetic neuralgia. Minerva Anestesiol . 2024 May;90(5).
26. Bourgeois C, Oyaert L, Van de Velde M, Pogatzki-Zahn E, Freys SM, Sauter AR, Joshi GP, Dewinter G. Pain management after laparoscopic cholecystectomy: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations. European Journal of Anaesthesiology| EJA. 2024 Nov 1;41(11):841-55.
27. 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 Apr 26;75(4):357-9.
28. Tanaka N, Suzuka T, Kadoya Y, Okamoto N, Sato M, Kawanishi H, Azuma C, Nishi M, Kawaguchi M. Efficacy of modified thoracoabdominal nerves block through perichondrial approach in open gynaecological surgery: a prospective observational pilot study and a cadaveric evaluation. BMC Anesthesiology. 2022 Apr 15;22(1):107.
29. Aikawa K, Miura M, Uchino T, Abe N, Yamauchi M. The potential suboptimal diffusion pattern of the local anaesthetic following modified thoracoabdominal nerve block through perichondrial approach (M-TAPA): an anatomical examination using a soft-embalmed Thiel cadaver. JCA Advances. 2024 Dec 1;1(3-4):100008.
30. Sawada A, Kumita S, Nitta A, Ohsaki Y, Yamakage M. Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA): an anatomical study to evaluate the spread of dye after a simulated injection in soft embalmed Thiel cadavers. Regional Anaesthesia & Pain Medicine. 2023 Aug 1;48(8):403-7.
31. Aikawa K, Tanaka N, Morimoto Y. Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides a sufficient postoperative analgesia for laparoscopic sleeve gastrectomy. J Clin Anesth. 2020 Feb 1;59:44-5.
32. Aikawa K, Uchinami Y, Morimoto Y. Chronological changes in plasma levobupivacaine concentrations after bilateral modified thoracoabdominal nerve block through perichondrial approach. Journal of Anaesthesia. 2023 Aug;37(4):641-4.
33. Genc C, Tulgar S, Akgun C, Avci MA, Yesilyurt B, Yildiz B, Cassai AD. Maximum extension and regression rate of cutaneous sensory block obtained with the external oblique intercostal block or the modified thoracoabdominal nerves block through perichondrial approach in patients undergoing laparoscopic cholecystectomy. Minerva anestesiologica. 2024 Nov;90(11):979-88.
34. 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 Journal of Anesthesiology. 2025 Apr 15.
35. Çiftçi B, Güngör H, Alver S, Akın AN, Özdenkaya Y, Tulgar S. Clinical experience for modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) in five patients. Dermatomal evaluation and application of different volumes: a case series and literature review. Turkish Journal of Anaesthesiology and Reanimation. 2023 Aug 18;51(4):354.
36. Bilgili B, Öztürk EG, Çabaklı GT, Teomete GC, Ergenç M. Bilateral Modified Thoracoabdominal Nerve Block Through a Perichondrial Approach in Patients Undergoing Major Abdominal Surgery: A Randomised Single-Blind Controlled Trial. Turkish Journal of Anaesthesiology and Reanimation. 2025 Feb 11;53(1):12.
37. Baytar Ç, Gürbüz Z, Köksal İncegül BG, Baytar MS, Taşdöven İ, Pişkin Ö. Effects of Modified Thoracoabdominal Nerves Block Through Pericondrial Approach on Postoperative Pulmonary Functions in Laparoscopic Bariatric Surgery: A Randomised Controlled Study. Obes Surg [Internet]. 2025;35(7):2461–70.
38. Aikawa K, Yokota I, Maeda Y, Morimoto Y. Evaluation of sensory loss obtained by modified-thoracoabdominal nerves block through perichondrial approach in patients undergoing gynecological laparoscopic surgery: a prospective observational study. Regional Anesthesia & Pain Medicine. 2021 Jul 18.
39. Castillo-Dávila LF, Torres-Anaya CJ, Vazquez-Apodaca R, Borboa-Olivares H, Espino-y-Sosa S, Torres-Torres J. Modified thoracoabdominal nerve block via perichondral approach: an alternative for perioperative pain management in laparoscopic cholecystectomy in a middle-income country. BMC anesthesiology. 2024 Aug 31;24(1):304.
40. Matsuura H, Terada Y, Rokkaku Y, Tamagawa H, Taniguchi E, Saito Y, Tsujimura N, Tanaka N, Kawaguchi M. Analgesic efficacy of modified thoracoabdominal nerves block through the perichondrial approach in laparoscopic cholecystectomy: a retrospective study with propensity analysis—Asian Journal of Endoscopic Surgery. 2023 Jul;16(3):648-52.
41. Atsumi C, Aikawa K, Takahashi K, Okada K, Morimoto Y. The comparison of postoperative analgesic requirements between modified thoracoabdominal nerve block through perichondrial approach versus wound infiltration analgesia in patients undergoing gynaecological laparoscopic surgery: a retrospective, exploratory study. JA Clinical Reports. 2023 Jun 24;9(1):39.
42. Nakazawa K, Watari T, Ikeda R, Suzuki T. Continuous Re-MTAPA Block via SEDIC Catheter Placement: A Novel Analgesia Technique in Two Complex Surgical Cases. Cureus. 2025 May 14;17(5).
43. Ohgoshi Y, Anetai H, Hanai S, Ichimura K, Kawagoe I. The key to success in blocking lateral cutaneous branches with a re-modified thoracoabdominal nerves block through the perichondrial approach: a newly discovered space between the endothoracic fascia, diaphragm, and costodiaphragmatic recess. Journal of Anaesthesia. 2024 Oct;38(5):642-9.
44. Ozen V, Acik ME, Ozen N. The modified thoracoabdominal nerve block for post-operative analgesia in paediatric laparoscopic cholecystectomy. Journal of Minimal Access Surgery. 2023 Jul 5.
45. Kumar A, Singh K, Sinha AK, Kandrakonda PK. Ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach for subcostal incision in a pediatric patient. Saudi Journal of Anaesthesia. 2022 Oct 1;16(4):516-7
46. Singh S, Pandey N. A new indication of ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach for thoracotomy in pediatric patients. Annals of Cardiac Anaesthesia. 2023 Oct 1;26(4):471-2.
47. Turan EI, Özen V, Gürel D, Şahin AS. Efficacy of modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) for analgesia in a pediatric patient operated for hydatid cyst. Minerva anestesiologica. 2025 Mar 13.
48. de Oliveira EJ, De Lima RC, Sakata RK, Freire TT, de Almeida Lima EL, de Oliveira CM, Moura EC, da Cunha Leal P. Modified thoracoabdominal nerve block through the perichondral approach (M-TAPA) in laparoscopic sleeve gastroplasty: a case series. Obesity Surgery. 2022 Jan;32(1):197-201.

Presenting Author: Dr Deepa Kerketta Khurana
Submitting Author: DEEPA KERKETTA KHURANA

Senior Author: Dr Deepa Kerketta Khurana

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Dr Dimple Pande: MD Anesthesia - VMMC & Safdarjung Hospital, New Delhi, India
• Dr Bhavya Krishna: MD Anaesthesia - VMMC & Safdarjung Hospital, New Delhi , India
• Dr Wahaja Karim: DNB Anaesthesia - Maulana Azad Medical College, New Delhi, India
• Dr Kavita Rani Sharma: MD Anaesthesia - VMMC & Safdarjung Hospital, New Delhi, India
• Dr Himanshu Khurana: MD Anaesthesia - Max Superspeciality Hospital, New Delhi, India