Comparison of postoperative analgesic effects of modified thoracoabdominal nerve block with combination of serratus intercostal plane block and rectus sheath block via ultrasound guided perichondrial approach in patients undergoing laparoscopic cholecystectomy

Aim: Severe postoperative pain is observed in patients following laparoscopic cholecystectomy. Currently, peripheral nerve blocks, which are a part of multimodal analgesia, are widely used in postoperative pain management. This study investigated the effects of modified thoracoabdominal nerve block (M-TAPA), rectus sheath block (RSB), and serratus intercostal plane block (SIPB) on postoperative NRS scores and tramadol consumption. Material and method: This study was designed as a prospective, randomized, and blinded trial. Seventy-two patients scheduled for laparoscopic cholecystectomy were included in the study. One group received a bilateral M-TAPA block (group 1, n=35), while the other group received a combination of bilateral RSB and right SIPB (group 2, n=37). For the peripheral nerve blocks, RSB was administered with 10 mL of 0.25% bupivacaine per side, M-TAPA with 20 mL of 0.25% bupivacaine per side, and SIPB on the right side with 20 mL of 0.25% bupivacaine. These blocks were performed after the surgery but before the termination of general anesthesia. The postoperative NRS scores and tramadol consumption were compared between the groups. Results: The groups were similar in terms of ASA scores and demographic characteristics. Static NRS scores measured at 0th, 1st, and 6th hours were found to be significantly different between the groups (P=0.001, P=0.017, P=0.016, respectively). Dynamic NRS scores evaluated at 0th, 12th, and 18th hours were also significantly different between the groups (P=0.007, P=0.032, P=0.042, respectively). The amount of tramadol consumed between 12-24 hours postoperatively was significantly higher in Group 2 compared to Group 1 (P=0.030). The number of patients requiring rescue analgesia in Group 2 was significantly higher than in Group 1 (P=0.034). Conclusion: The combination of M-TAPA and RKB with SIPB is effective in managing postoperative pain in LC operations. However, the M-TAPA block group exhibited lower NRS scores and reduced opioid consumption. Keywords: Laparoscopic cholecystectomy, Postoperative pain, Modified thoracoabdominal plane block, Serratus intercostal plane block, Rectus sheath block