Ultrasound-Guided Bilateral Modified-Thoracoabdominal Nerve Block Through a Perichondral Approach in a Patient Undergoing Bilateral Laparoscopic Inguinal Hernia Repair: A Case Report.

Abstract

Background: Modified thoracoabdominal nerve block through the perichondrial approach (M TAPA), described by Tulgar et al in 2019, is a relatively new block. The block is relatively superficial and easy to perform. It has been successfully used in various laparoscopic surgeries and has been shown to reduce the perioperative opioid requirements.

Case presentation: We report the case of a 41-year-old male with ASA grade 2, who was scheduled to undergo laparoscopic unilateral inguinal hernia repair. The patient had General Anaesthesia with bilateral M TAPA using 30 mL of 0.25% levobupivacaine on each side before the incision. Intraoperatively, the surgeon decided that the patient would require bilateral inguinal hernia repair. The patient received 100 µg fentanyl at induction, and intravenous paracetamol and ketorolac intraoperatively. The surgery was uneventful, and the patient was transferred to a post anaesthesia care unit. In the postoperative period, the patient did not require opioids and received only two doses each of paracetamol and ketorolac. The patient was discharged the following day, without any further sequelae.

Conclusion: When administered bilaterally, MTAPA can provide adequate analgesia and has opioid-sparing effects in both the intra and postoperative periods.