Comparing perichondrial M-TAPA and subcostal OSTAP blocks in laparoscopic hernia repair: A randomized, non-inferiority trial

Objectives: The modified thoracoabdominal nerves block through the perichondrial approach (M-TAPA) and the oblique subcostal transversus abdominis plane block (OSTAP) provide effective analgesia management after abdominal surgeries. There are limited studies comparing these two blocks in the literature. We aimed to compare M-TAPA and OSTAP in patients who underwent laparoscopic inguinal hernia repair.
Methods: Patients with ASA status I–II, aged between 18 and 65 years, scheduled for elective TAPP under general anesthesia were included in the study. The patients were randomized into two groups: Group M-TAPA (n=30) and Group OSTAP (n=30). Blocks were performed using a total of 60 ml of 0.25% bupivacaine (30 ml per side). Postoperatively, all patients were routinely prescribed intravenous ibuprofen 400 mg three times a day. If a patient’s NRS score was ≥4 at any time, a dose of 100 mg intravenous tramadol was administered for rescue analgesia.
Results: The duration of the block procedure was significantly longer in the OSTAP group. The need for rescue analgesia and opioid consumption were similar between the groups. In the first two postoperative hours, static and dynamic NRS scores were lower in the M-TAPA group than in the OSTAP group. There were no differences between the groups in terms of the rate of adverse events. Patient satisfaction (Likert scale) was higher in the M-TAPA group.
Conclusion: The M-TAPA block is not inferior to the OSTAP block following laparoscopic inguinal hernia repair surgery. Moreover, the M-TAPA block may be an alternative option to the OSTAP block, as it is easy to apply.

Keywords: Laparoscopic inguinal hernia, M-TAPA block, OSTAP block, postoperative analgesia.