Postoperative Analgesic Effectiveness of the Modified Thoracoabdominal Nerve Block Through a Perichondrial Approach in Total Laparoscopic Hysterectomy

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.

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.