Modified thoracoabdominal nerves block through perichondrial approach for surgical patients: a scoping review

Background: Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) is a trunk block that has been gaining attention for managing postoperative pain following abdominal surgeries since its first report in 2019. We conducted a scoping review on M-TAPA, aiming to comprehensively evaluate existing research, identify the gaps in knowledge, and understand the implications of M-TAPA.

Methods: This scoping review was conducted using databases including PubMed, Embase, Cochrane, and CINAHL to evaluate the clinical efficacy of M-TAPA on April 19, 2024. Background and outcomes including anesthetized dermatomes, postoperative pain, opioid consumption, quality of recovery, duration to perform, and plasma local anesthetic concentrations were assessed. All reports involving patients, including randomized controlled trials, observational studies, case series, and case reports regarding M-TAPA, were included without language or age restrictions. The included studies were analyzed based on their methodology and clinical relevance.

Results: Anesthetized dermatomes were mainly observed in anterior cutaneous branch T7-11. Lateral cutaneous branch T8-10 also anesthetized; however, the probability was lower than anterior cutaneous branch area. M-TAPA has been investigated mostly in laparoscopic cholecystectomy; although its potential to outperform non-block and wound infiltration has been suggested, it did not clearly outperform the transversus abdominis plane block.

Conclusions: M-TAPA may be considered a promising technique for postoperative pain management in upper abdominal laparoscopic surgeries. Further studies are warranted to elucidate the precise mechanisms and broader surgical applications.