Ultrasound Guided Modified Thoracoabdominal Nerve Block Through Perichondrial Approach (M-TAPA) Versus Quadratus Lumborum Block for Postoperative Analgesia in Laparoscopic Cholecystectomy

NCT ID: NCT06588777

Last Updated: 2025-09-30

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 52 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2024-09-01
• Study Completion Date: 2025-12-30

Brief Summary

This study aims to compare the efficacy of using Ultrasound guided modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) versus quadratus lumborum block for postoperative analgesia in laparoscopic cholecystectomy under general anesthesia.

Conditions

Laparoscopic Cholecystectomy; Modified Thoracoabdominal Nerve Block; Quadratus Lumborum Block

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: SINGLE

Study Groups

Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA)

Using the in plane technique A deep angle was given to the costochondral angle at the edge of the 10th costal margin with the probe in the sagittal direction to view the lower surface of the costal cartilage in the midline. A 22-G, 100-mm block needle will be inserted in the cranial direction using the in-plane technique and the needle tip will be moved to the posterior aspect of the 10th costal cartilage. It is noted that the needle tip never crossed the cranial edge of the 10th costal cartilage and 20 mL of 0.25% bupivacaine will be injected into the lower surface of the chondrium to make Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA).

Group Type: EXPERIMENTAL

Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA)

Intervention Type: PROCEDURE

transversus abdominis, internal oblique, and external oblique muscles will be identified with a high-frequency (10 MHz) linear probe on the costochondral angle in the sagittal plane under ultrasound guidance at the 10th costal margin. A deep angle was given to the costochondral angle at the edge of the 10th costal margin with the probe in the sagittal direction to view the lower surface of the costal cartilage in the midline. A 22-G, 100-mm block needle will be inserted in the cranial direction using the in-plane technique and the needle tip will be moved to the posterior aspect of the 10th costal cartilage. It is noted that the needle tip never crossed the cranial edge of the 10th costal cartilage

Quadratus lumborum block

Using the in plane technique the probe will be placed in the mid-axillary line between the lower costal margin and the iliac crest in a transverse plane to view all abdominal layers. The probe will be moved towards the posterior axillary line, to reach a point where all three abdominal muscle layers merge to form aponeurosis.

The aponeurosis will then be followed dorsally until the quadratus lumborum muscle is seen deep to transversalis fascia with its attachment to the transverse process of the L4 vertebral body. A 22 G, 100 mm, blunt, insulated nerve block needle will be inserted 1 cm medial to the probe and advanced using the in-plane technique with ultrasound real-time assessment. The injection site will be the junction of transversalis fascia and the anterolateral border of quadratus lumborum muscle.

Group Type: EXPERIMENTAL

Quadratus lumborum block

Intervention Type: PROCEDURE

using ultrasound guidance (Sonosite turbo M, Bothell, Washington, USA) and a curved ultrasound probe (2.5-7.5 MHz). The probe will be placed in the mid-axillary line between the lower costal margin and the iliac crest in a transverse plane to view all abdominal layers. The probe will be moved towards the posterior axillary line, to reach a point where all three abdominal muscle layers merge to form aponeurosis.

The aponeurosis will then be followed dorsally until the quadratus lumborum muscle is seen deep to transversalis fascia with its attachment to the transverse process of the L4 vertebral body. A 22 G, 100 mm, blunt, insulated nerve block needle will be inserted 1 cm medial to the probe and advanced using the in-plane technique with ultrasound real-time assessment. The injection site will be the junction of transversalis fascia and the anterolateral border of quadratus lumborum muscle

Interventions

Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA)

transversus abdominis, internal oblique, and external oblique muscles will be identified with a high-frequency (10 MHz) linear probe on the costochondral angle in the sagittal plane under ultrasound guidance at the 10th costal margin. A deep angle was given to the costochondral angle at the edge of the 10th costal margin with the probe in the sagittal direction to view the lower surface of the costal cartilage in the midline. A 22-G, 100-mm block needle will be inserted in the cranial direction using the in-plane technique and the needle tip will be moved to the posterior aspect of the 10th costal cartilage. It is noted that the needle tip never crossed the cranial edge of the 10th costal cartilage

Intervention Type: PROCEDURE

Quadratus lumborum block

using ultrasound guidance (Sonosite turbo M, Bothell, Washington, USA) and a curved ultrasound probe (2.5-7.5 MHz). The probe will be placed in the mid-axillary line between the lower costal margin and the iliac crest in a transverse plane to view all abdominal layers. The probe will be moved towards the posterior axillary line, to reach a point where all three abdominal muscle layers merge to form aponeurosis.

The aponeurosis will then be followed dorsally until the quadratus lumborum muscle is seen deep to transversalis fascia with its attachment to the transverse process of the L4 vertebral body. A 22 G, 100 mm, blunt, insulated nerve block needle will be inserted 1 cm medial to the probe and advanced using the in-plane technique with ultrasound real-time assessment. The injection site will be the junction of transversalis fascia and the anterolateral border of quadratus lumborum muscle

Intervention Type: PROCEDURE

Other Intervention Names

(M-TAPA); (QLB)

Eligibility Criteria

Inclusion Criteria

• Adult patients aging ≥ 21 years to ≤ 70 of both sexes.
• Patients undergoing Laparoscopic cholecystectomy surgeries.
• ASA physical status classes I - II.

Exclusion Criteria

• Patient's refusal of procedure or participation in the study.
• ASA classes III or above.
• Coagulopathy and bleeding disorders.
• Evidence of Local skin infections at site of injection.
• Body mass index >40kg/m2
• A history of relevant local anesthetic allergy.

• Minimum Eligible Age: 21 Years
• Maximum Eligible Age: 71 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Ain Shams University

OTHER

Sponsor Role: lead

Responsible Party

Ahmed Hassan Helmy

Clinical Doctor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Ainshams university hospitals

Cairo, , Egypt

Site Status: RECRUITING

Countries

Egypt

Central Contacts

Ahmed Hassan, Master

Role: CONTACT

ahmedhassan199466@gmail.com

01158195158

Facility Contacts

Ainshams

Role: primary

Other Identifiers

MD92/2024

Identifier Type: -

Identifier Source: org_study_id