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The goal of this study is to compare the analgesic efficacy of M-TAPA block and TAP block in patients undergoing laparoscopic appendectomy surgeries
There will be two randomized groups: Group M-TAPA (n=15), Group TAP (n=15). All patients will have standard general anesthesia. Group M-TAPA patients will receive bilateral M-TAPA block with 0.25% bupivacaine (total volume of 40 ml). Group TAP patients will have bilateral lateral-TAP block with 0.25% bupivacaine (total volume of 40 ml). All blocks will be performed after general anesthesia induction, before skin incision. All patients in the study will receive 50 mg dexketoprofen and 1 gr paracetamol intravenos (i.v.) 10 minutes prior to skin closure. All patients will have ibuprofen 3x400 mg in postoperative 24 hours (maximum dose 1200 mg/day). Numerical rating scale (NRS) will be used to assess postoperative pain on 1st, 6th, 12th, 18th and 24th hour after the surgery. 50 mg tramadol will be administered as a rescue analgesic in all patients.Total tramadol consumption will be calculated.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| M-TAPA | Active Comparator | Patients will have bilateral M-TAPA block with 0.25% bupivacaine (total volume of 40 ml) before the surgery for postoperative pain control. |
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| TAP | Active Comparator | Patients will have bilateral lateral-TAP block with 0.25% bupivacaine (total volume of 40 ml) before the surgery for postoperative pain control. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| M-TAPA block with bupivacaine 25% | Other | Following sterile conditions for bilateral M-TAPA block application, the transducer will be inserted on the chondrium in the sagittal plane at the 9-10th rib level. Subsequently, a deep angle will be created with the probe for visualization of the underside of the costochondrium. The sonovisible needle tip will be placed just below the chondrium and saline (5 ml) will be injected for site confirmation. After the confirmation, 20 ml of 0.25% bupivacaine will be administered for each group for a total of 40 ml of local anesthetic. Blocks will be applied using an 80 mm sonovisible needle with a 6-10 MHz linear probe under the guidance of a portable ultrasound. M-TAPA block with the same standard technique and drug dose will be applied to the contralateral side for each group of M-TAPA patients. |
| Measure | Description | Time Frame |
|---|---|---|
| Comparing the numerical rating scale scores | Numerical rating scale will be used for pain assessment. The scores of the numerical rating scale changes between 0 to 10 points. 10 points mean "the most severe pain that the patient ever had". 0 point means "there is no pain." Higher scores mean worse outcome. | Postoperative 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Comparing total tramadol consumption | Postoperative analgesic need | Postoperative 24 hours |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Oğuz Gündoğdu | Contact | +905545945469 | droguzgundogdu@gmail.com | |
| Onur Avcı | Contact | +905301126408 | dronuravci@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Oğuz Gündoğdu | Sivas Cumhuriyet University School of Medicine, Anesthesiology and Reanimation | Principal Investigator |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| TAP block with bupivacaine 25% | Other | After the necessary sterilization conditions established, the linear ultrasound probe will be placed in the middle of the iliac crest with the end limit of the ribs. Starting with skin, the layers in descending order, subcutaneous adipose tissue, external oblique muscle, internal oblique muscle, transversus abdominis muscle, and peritoneum will be identified. As the tip of the 80 mm sonovisible needle passes through the muscular layers and fascia, the needle will be advanced in a controlled manner. After receiving the click sensation (passage of the fascia of the internal oblique muscle), the location of the needle will be fixed and 20 ml of 0.25% bupivacaine will be injected between internal oblique and transversus abdominis muscles. Same procedure will be performed to the other site. (40 ml local anesthetics in total) |
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| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |