Discussion
postoperative pain, nausea and vomiting, pain, pulmonary and cardiac complications, PONV, NRS, 7–11
SIDE EFFECT, POSTOPERATIVE COMPLICATIONS, ADVERSE EVENTS, CHRONIC PAIN, PNEUMOPERITONEUM
The present study is the first randomized, double-blind clinical trial that compared M-TAPA block with OSTAP block in LC. The study showed that USG-guided bilateral M-TAPA block following the induction of general anesthesia in LC patients reduced the total tramadol requirement in the first 24 h compared to the group OSTAP. Also, NRS scores were less than 4 at almost all time points and were similar in the groups. No differences were detected between the groups in terms of postoperative complications and quality of recovery. The number of dermatomes blocked in the anterior and lateral abdominal wall in group M-TAPA was higher than in group OSTAP.Severe pain is associated with delayed postoperative ambulation, decreased patient satisfaction, development of chronic pain, and increased pulmonary and cardiac complications. For this reason, it has great importance to define optimal analgesic strategies for surgical procedures causing moderate-severe pain. It is important to understand the trigger and source of postoperative pain in LC. Most of the postoperative pain components (50–70%) originate from the incision sites following LC, and pneumoperitoneum (20–30%) and cholecystectomy (10–20%) also cause pain [The anterior abdominal wall is primarily formed by the rectus abdominis muscle innervated by the T6-L1 spinal nerves [It was reported that OSTAP block affects anterior abdominal wall predominantly with a limited extent lateral abdominal wall [TAPA block, described by Tulgar et al., is a novel regional technique that provides analgesic effects in the anterior and lateral regions of the abdominal wall by injecting a local anesthetic into the lower and upper parts of the chondrium at the costochondral corner [Various case reports showed that M-TAPA block leads to successful and effective postoperative analgesia in abdominal surgeries. It was reported that M-TAPA block leads to satisfactory analgesia without a prescription of opioid in a case operated with a midline incision below and above the umbilicus. Moreover, M-TAPA block and catheter placement was performed in 2 patients who underwent major abdominal surgery, and it was found to be beneficial [Various predictions for the mechanism of action of M-TAPA block were made previously in cadaveric studies. In their cadaver study, Tanaka et al. mentioned the existence of a “tunnel” structure between the costal cartilage and the origin of the Transversus Abdominis Muscle (TAM). Since this part was found stained with dye after dissection at the end of the study, they explained the spread of local anesthetic agents to the cranial side without obstruction of the linea semilunaris [In the present study, it was found that M-TAPA block could spread from T4 to L1 in the anterior region, T3-T12 Dermatomes were blocked in the lateral region in some patients, and no loss of sensation was observed in the lateral region in 4 patients.The deeper fibers of the anterior and lateral cutaneous branches of the 7–11 thoracic intercostal nerves, which partially innervate the parietal peritoneum might affect visceral pain [In anesthetized patients, postoperative recovery is a multidimensional and reticular process with several interrelated areas and is not limited to postoperative pain. For this reason, the QoR-15 questionnaire, which is a Turkish-validated post-surgical quality assessment tool that can compare patient-centered outcomes to assess and improve the quality of care, was created [The study was conducted to show the postoperative pain and quality of recovery between a novel technique, M-TAPA block, and OSTAP block, and to compare the consumption of postoperative analgesic agents. The results showed no difference except for 24-hour opioid consumption and showed that M-TAPA and OSTAP blocks had similar effects. This report is relatively recent and the study is the first controlled study comparing OSTAP block with a new and different regional anesthesia technique, M-TAPA block.The study had several limitations. Although morphine consumption is generally used as a comparison in studies evaluating regional anesthesia techniques, tramadol was preferred in the study since it was shown that it has the same effects as morphine in patients undergoing LC, the effects are seen in a shorter time and the side effect profile is less [The sample size of the present study was calculated for the minimum number of patients required for tramadol consumption to find a statistically significant difference in the results. However, there was insufficient power to analyze common adverse events related to nausea and vomiting, such as PONV and sedation scores with the current sample size.