USG-Guided TAPA vs RIFB Block for Postoperative Analgesia in Laparoscopic Cholecystectomy
Comparison of Ultrasonography-Guided the Postoperative Analgesic Efficacy of Perichondrial Approach Modified Thoracoabdominal Nerve Block and Recto-Intercostal Fascial Plan Block in Patients Who Underwent Laparoscopic Cholecystectomy
Hitit University
70 participants
Mar 16, 2025
INTERVENTIONAL
Conditions
Summary
Laparoscopic cholecystectomy (LC) can cause moderate-to-severe postoperative pain from visceral, referred shoulder, and incisional sources. Multimodal analgesia is recommended, but opioids carry significant side effects. Ultrasound-guided interfascial plane blocks offer a safe alternative. The Modified Thoracoabdominal Nerve Block through Perichondrial Approach (M-TAPA) blocks T5-T12 dermatomes, while the Recto-Intercostal Fascial Plane Block (RIFPB) provides sensory blockade across the upper anterolateral abdomen. This study compares the postoperative analgesic efficacy of bilateral M-TAPA versus bilateral RIFPB in patients undergoing LC.
Eligibility
Inclusion Criteria8
- Age 18-65 years
- ASA physical classification I-II
- BMI < 35 kg/m²
- Scheduled for elective laparoscopic cholecystectomy due to cholelithiasis
- Able to use and understand the NRS pain scoring system
- Able to use and understand the QoR-15 scale
- Able to communicate in Turkish
- Provided written informed consent
Exclusion Criteria24
- Refusal to participate in the study
- BMI > 35 kg/m²
- ASA physical classification III-V
- Age < 18 or > 65 years
- Allergy to local anesthetics or study analgesics
- Pregnancy or breastfeeding
- Inability to use or understand the NRS pain scoring system or QoR-15 scale
- Inability to communicate in Turkish
- Uncontrolled anxiety disorder
- Alcohol or drug dependency
- Neuromuscular or peripheral nerve disease
- High-dose opioid use within 3 days prior to surgery
- Widespread chronic pain
- Diabetes mellitus
- Hepatic or renal insufficiency
- Coagulation disorders or anticoagulant use
- Infection at the block needle insertion site
- Concurrent second surgical procedure alongside laparoscopic cholecystectomy
- Previous abdominal surgery or trauma history
- Conversion from laparoscopic to open surgery
- Technical problems with the PCA device
- NRS score > 7 for four consecutive hours despite multimodal analgesia
- Planned postoperative non-extubation
- Termination of surgery before completion for any reason
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Interventions
Patients receiving ultrasound-guided bilateral Modified Thoracoabdominal Nerve Block through Perichondrial Approach (M-TAPA) using 20 ml of 0.25% bupivacaine per side, applied at the 10th rib level beneath the costochondral perichondrium after surgery while under anesthesia.
Patients receiving ultrasound-guided bilateral Recto-Intercostal Fascial Plane Block (RIFPB) using 20 ml of 0.25% bupivacaine per side, injected into the interfascial plane between the rectus abdominis muscle and the 6th-7th costal cartilages just below the xiphoid process, applied after surgery while under anesthesia.
Locations(1)
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NCT07552701