Hysterectomy, Postoperative Pain
Conditions
Keywords
Modified thoracoabdominal nerves block through perichondrial approach, M-TAPA, Regional anesthesia, Postoperative analgesia
Brief summary
This single-center retrospective cohort study evaluated the effect of the modified thoracoabdominal nerves block through a perichondrial approach (M-TAPA) on postoperative analgesia in patients undergoing elective total laparoscopic hysterectomy. Medical records of 60 patients who underwent surgery at Tekirdag Namik Kemal University Faculty of Medicine Hospital between December 25, 2023 and December 25, 2024 were retrospectively reviewed. Patients who received bilateral ultrasound-guided M-TAPA block were compared with patients who received standard general anesthesia and systemic analgesia without M-TAPA block. The primary outcome was cumulative tramadol consumption during the first 24 postoperative hours. Secondary outcomes included postoperative Visual Analog Scale (VAS) pain scores at predefined time points, rescue analgesic requirements, postoperative nausea and vomiting, Quality of Recovery-15 (QoR-15) scores, and block-related complications.
Detailed description
Postoperative pain following total laparoscopic hysterectomy remains an important clinical concern because inadequate analgesia may delay mobilization, prolong recovery, increase opioid consumption, and reduce patient satisfaction. Ultrasound-guided fascial plane blocks have become an important component of multimodal analgesia strategies. The modified thoracoabdominal nerves block through a perichondrial approach (M-TAPA) is a relatively new regional anesthesia technique that provides analgesia of the anterior thoracoabdominal wall by targeting the thoracoabdominal nerves beneath the costal cartilage. This single-center retrospective cohort study reviewed the medical records of patients who underwent elective total laparoscopic hysterectomy at Tekirdag Namik Kemal University Faculty of Medicine Hospital between December 25, 2023 and December 25, 2024. After application of predefined inclusion and exclusion criteria, 60 patients were included in the analysis. Thirty patients received bilateral ultrasound-guided M-TAPA block with 20 mL of 0.25% bupivacaine on each side (total volume: 40 mL) in addition to standard general anesthesia, whereas 30 patients received standard general anesthesia and systemic analgesia without M-TAPA block. The primary outcome was cumulative tramadol consumption during the first 24 postoperative hours. Secondary outcomes included postoperative Visual Analog Scale (VAS) pain scores at 0, 6, 12, and 24 hours after surgery, rescue analgesic requirements, postoperative nausea and vomiting, Quality of Recovery-15 (QoR-15) scores at 24 hours, and block-related complications documented in the medical records. The study was approved by the Tekirdag Namik Kemal University Non-Interventional Clinical Research Ethics Committee (Approval No. 2025.11.01.11) before data collection and was conducted in accordance with institutional and ethical standards.
Interventions
PROCEDUREModified thoracoabdominal nerves block through a perichondrial approach (M-TAPA)
Bilateral ultrasound-guided modified thoracoabdominal nerves block through a perichondrial approach using 20 mL of 0.25% bupivacaine on each side (total volume: 40 mL), performed before surgical incision as part of multimodal analgesia.
Sponsors
Namik Kemal University
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Female patients aged 18 to 65 years. * American Society of Anesthesiologists (ASA) physical status I or II. * Undergoing elective total laparoscopic hysterectomy under general anesthesia. * Availability of complete perioperative and postoperative medical records.
Exclusion criteria
* Neurological disorders affecting pain perception. * Coagulopathy or bleeding disorders. * Known allergy to local anesthetics. * Chronic opioid use before surgery. * Body mass index (BMI) greater than 35 kg/m². * Incomplete medical records.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cumulative tramadol consumption during the first 24 postoperative hours | During the first 24 postoperative hours | Total tramadol consumption delivered by patient-controlled analgesia (PCA) during the first 24 postoperative hours. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain intensity | At 0, 6, 12, and 24 hours after surgery | Postoperative pain intensity assessed using the Visual Analog Scale (VAS). The VAS ranges from 0 to 10, where 0 indicates no pain, 10 indicates the worst imaginable pain, and higher scores indicate greater pain intensity. |
| Quality of recovery (QoR-15) | At 24 hours after surgery | Postoperative recovery quality assessed using the validated Quality of Recovery-15 (QoR-15) questionnaire. The QoR-15 score ranges from 0 to 150, with higher scores indicating better postoperative recovery. |
| Rescue analgesic requirements | During the first 24 hours after surgery | Requirement for additional rescue analgesic medication when postoperative pain remained inadequately controlled despite patient-controlled analgesia. |
| Postoperative nausea and vomiting | During the first 24 hours after surgery | Incidence of postoperative nausea and vomiting documented in the medical records. |
| Block-related complications | During the first 24 postoperative hours | Complications related to bilateral ultrasound-guided modified thoracoabdominal nerves block through a perichondrial approach documented in the medical records. |
Countries
Turkey (Türkiye)
Outcome results
None listed