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Abstract
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Background and Aims The objective of the present study was to evaluate morphine consumption and pain scores 24 hours postoperatively to compare the effects of a bilateral External Oblique Intercostal (EOI) block with those of a Modified Thoracoabdominal Nerve Block Trough Perichondrial Approach (M-TAPA) block in laparoscopic sleeve gastrectomy (LSG).
Methods Fifty-eight patients aged between 18 and 65 years of with American Society of Anesthesiologists class II-III were included in this prospective, randomized, double blinded study. Patients were assigned into two groups either EOI block or M-TAPA block. The primary outcome was cumulative morphine consumption within the first postoperative 24 hours. Secondary outcomes were numerical rating scale (NRS) scores at rest and during activity, QoR-15 Patient Questionnaire scores, incidence of postoperative nausea and vomiting (PONV), number of patients requiring rescue analgesic and antiemetics drugs, and complications.
Results There was no statistically significant difference between the groups in terms of morphine consumption in the first 24 hours (EOI block; 10.74 ± 3.94 mg vs. M-TAPA block; 11.67 ± 4.66 mg, respectively). In addition, no significant difference between the two groups in the NRS and PONV scores, total QoR-15 scores, and the number of patients requiring rescue analgesics and antiemetics.
(A) The sonoanatomy relevant for the EOI block. (B) Schematic illustration of where to inject local anesthetic when using an ultrasound-guided EOI block. The blue highlighted area is the desired spread of local anaesthetic. EOI, external oblique intercostal block; EOM, external oblique muscle; ICM, intercostal muscles; LA, local anesthetic. (C) The sonoanatomy relevant for the M-TAPA block. (D) Schematic illustration of where to inject local anesthetic when using an ultrasound-guided M-TAPA block. The blue highlighted area is the desired spread of local anesthetic. CC, Costal Cartilage; EOM, external oblique muscle; IOM, internal oblique muscle; TAM, transversus abdominis muscle; ICM, intercostal muscles; M-TAPA, Modified Thoracoabdominal Nerve Block Through Perichondrial Approach, LA, local anesthetic
Patient demographic and surgical characteristics and clinical outcomes
Comparison of the resting and activity NRS scores between groups
Conclusions EOI block and M-TAPA block showed similar effectiveness for morphine consumption within 24 hours postoperatively and in pain scores in LSG.