Comparison of the effects of two differents blocks on postoperative analgesia in laparoscopic cholecystectomy

Modified thoracoabdominal nerves block through perichondrial approach: Modified thoracoabdominal nerves block through perichondrial approach (m-tapa) is a type of block used for postoperative analgesia in various abdominal surgeries, reported to provide abdominal analgesia by blocking both the anterior and lateral cutaneous branches of the thoracabdominal nerves by applying local anesthesia to the underside of the costochondral chondrium at the 9th and 10th costal levels. Before surgery began, after ensuring appropriate sterilization, a linear ultrasonography (USG) probe was aseptically inserted into the costochondral angle at the level of the 9th and 10th ribs in the sagittal plane. The transverse abdominis muscle, internal oblique muscle, and external oblique muscle were visualized. The probe was then angled deeply to visualize the underside of the chondrium. Using the in-plane technique, an 80 mm 22-gauge peripheral blocking needle (Stimuplex®, B Braun, Melsungen, Germany) was guided caudally to the cephalad plane, advancing the needle tip to the underside of the chondrium. After confirming the absence of vascular access by aspiration, an M-TAPA block was performed by injecting 20 ml of 0.25% bupivacaine (Buvasin vial, Vem, Istanbul, Türkiye). All M-tapas were performed by an anesthesiologist who has been working for at least 5 years. Anesthesia was maintained with 50% O2 + 50% air with 6% desflurane (Suprane®, Baxter, USA), fentanyl, and rocuronium titration. Any complications related to the block were recorded during intraoperative follow-up. At the end of surgery, patients were antagonized with 2 mg/kg sugammadex (Bridion®, Sanofi, Tekirdag, Turkey) after the inhaled agent was removed and the muscle relaxant effect was antagonized. After extubation, they were taken to the postoperative recovery room. Arrival time to the recovery room was considered 0. The first VAS assessment of patients who underwent M-TAPA was performed here.Any side effects or complications such as hypotension, vascular puncture, paresthesia, and local anesthetic toxicity that developed during block application were documented. Patients who met the recovery criteria were followed up in the general surgery clinic. Demographic data obtained from postoperative recovery room and ward follow-ups of all patients, postoperative rest and dynamic VAS scores at 0, 2, 4, 6, 8, 12, and 24 hours, and patient satisfaction at 24 hours were reviewed and recorded. The time of first analgesic use at 24 hours postoperatively was recorded on the case report form.