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ESRA19-0506 Ultrasound guided blockade of thoracoabdominal nerves through perichondrial approach (TAPA) for postoperative analgesia in abdominal surgeries: case series
  1. S Tulgar,
  2. O Senturk and
  3. O Selvi
  1. Maltepe University Faculty of Medicine, Anesthesiology and Reanimation, Istanbul, Turkey


Background and aims Ultrasound guided (USG) ‘the blockade of ThoracoAbdominal nerves through Perichondrial Approach’(TAPA) is a new block we recently described. Its sensory block was reported between Th5-Th12 dermatomes from the mid-axillary line to mid-abdomen/sternum. The modification of TAPA (M-TAPA) was also effectively used in major abdominal surgeries. In this case series, we present TAPA and M-TAPA applied for postoperative analgesia in abdominal surgery patients.

Methods We performed TAPA and M-TAPA blocks unilaterally and bilaterally in abdominal surgery patients in our clinic after obtaining written informed consent. In M-TAPA, 20–30 mL of local anesthetic (LA) was applied interfascially between lower surface costochondral tissue and the upper fascia of the transversus abdominis muscle in the 9th and 10th midclavicular line. In TAPA, additional to this injection supplementary 10–20 mL of LA is applied between the upper surface of the condrium and the deep fascia of the external oblique muscle.

Results In 8 different operations, 4 patients had right, 9 patients had bilateral TAPA and 9 patients had M-TAPA. The types of surgery, ASA scores, 24-hour analgesic requirements, the numeric rating scale (NRS) scores followed for patients’ pain level are presented in table 1 and figure 1. The mean paracetamol and tramadol consumption were 2.36 ± 0.84 g/day 62.72 ± 49.29 mg/day respectively.

Abstract ESRA19-0506 Table 1
Abstract ESRA19-0506 Figure 1

Conclusions USG guided TAPA and M-TAPA blocks are an effective regional anesthetic technique in laparoscopic and open abdominal surgeries when selected by considering sensory innervation of the surgical field.

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