Comparison of M-TAPA, EOIP, and Local Infiltration for Pain Relief After Laparoscopic Cholecystectomy

This retrospective observational study aimed to compare three pain management techniques used after laparoscopic gallbladder removal (cholecystectomy): modified thoracoabdominal nerve block through the perichondrial approach (M-TAPA), external oblique intercostal plane (EOIP) block, and local anesthetic infiltration. The study included 90 adult patients who underwent elective laparoscopic cholecystectomy between January and April 2025. Patients were divided into three groups according to the pain management technique they received during routine clinical care, with 30 patients in each group. The primary outcome was pain intensity measured 2 hours after surgery using a visual analog scale (VAS). Additional outcomes included pain scores at 15 minutes and 4, 8, 16, and 24 hours after surgery, the need for additional opioid pain medication, and opioid-related adverse events. The study aimed to evaluate differences in postoperative pain control and the need for additional pain medication among these three techniques using previously collected medical records.

Inclusion Criteria: Adults aged 18 years or older. American Society of Anesthesiologists (ASA) physical status I-II. Patients who underwent elective laparoscopic cholecystectomy under general anesthesia between January and April 2025. Patients who received M-TAPA block, EOIP block, or local anesthetic infiltration as part of routine clinical care. Availability of complete medical records for postoperative pain assessment and analgesic outcomes Exclusion Criteria: Major organ failure, including renal, hepatic, or cardiac failure. Significant cardiovascular conditions, including atrioventricular block, unstable angina, myocardial infarction within the preceding 6 weeks, heart rate below 50 beats/min, or systolic blood pressure below 90 mmHg. Body mass index (BMI) ≥35 kg/m². Neurological or psychiatric disorders that could impair communication or pain assessment. Use of antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, or mirtazapine. Patients requiring additional surgical procedures. Patients undergoing anesthesia other than general anesthesia. Incomplete medical records.