Modified Thoracoabdominal Nerves Block Through the Perichondrial Approach vs Subcostal Transversus Abdominis Plane Block for Postoperative Recovery After Laparoscopic Cholecystectomy: A Prospective, Randomized Clinical Trial.

BACKGROUND This study compared the effects of ultrasound-guided modified thoracoabdominal nerves block through the perichondrial approach (M-TAPA) and subcostal transversus abdominis plane (TAP) block on postoperative recovery after laparoscopic cholecystectomy. MATERIAL AND METHODS Sixty patients aged 18-65 years with American Society of Anesthesiologists physical status I-II undergoing elective laparoscopic cholecystectomy under general anesthesia were included. At the end of surgery, patients were randomly assigned to receive either ultrasound-guided subcostal TAP block (group T, n=30) or M-TAPA block (group M, n=30), with 20 mL of 0.25% bupivacaine administered on each side. Primary outcome was postoperative recovery at 24 hours (Quality of Recovery-15 [QoR-15] questionnaire). Secondary outcomes included postoperative pain scores (numerical rating scale [NRS]) at 0, 2, 4, 8, 16, and 24 hours, rescue analgesic requirements, and postoperative adverse effects. RESULTS The groups were comparable in age, height, weight, duration of surgery, and anesthesia-related variables (all P>0.05). Twenty-four-hour QoR-15 scores were similar between groups (P>0.05). Likewise, NRS pain scores did not differ significantly between groups (P>0.05). Significantly fewer patients required rescue analgesia in group M than in group T (30.0% vs 60.0%, P=0.020). Total rescue analgesic dose did not differ between groups (P=0.943). Postoperative adverse effects were comparable (P>0.05). CONCLUSIONS In patients undergoing laparoscopic cholecystectomy, ultrasound-guided M-TAPA block did not provide superior postoperative recovery, as assessed by QoR-15, compared with subcostal TAP block. Nevertheless, significantly fewer patients in the M-TAPA group required rescue analgesia (30.0% vs 60.0%, P=0.020), although total rescue analgesic consumption was similar between the groups.