M-TAPA vs. Combined M-TAPA + EXOP for Postoperative Pain in Laparoscopic Gynecologic Surgery

NCT07264855 | Recruiting

• 1 other identifier: 2025/312
• Study Type: observational
• Target: 86
• Locations: 1 country
• Sites: 1

Brief Summary

Laparoscopic gynecologic surgery is less invasive than open surgery, but many patients still experience pain after the procedure. M-TAPA and EXOP are ultrasound-guided regional anesthesia techniques used to reduce abdominal pain. Previous research suggests that M-TAPA provides effective pain relief on the anterior abdominal wall, while EXOP may help reduce pain in the lateral abdominal region. This study aims to determine whether combining M-TAPA with EXOP provides better postoperative pain control than using M-TAPA alone. The study will compare pain scores during the first 24 hours after surgery, the need for rescue analgesic medication, and recovery quality using the QoR-15 questionnaire. All procedures are part of routine clinical care, and no experimental drugs or devices are used.

Conditions

Laparoscopic Gynecologic Surgery; Postoperative Pain

Keywords

M-TAPA block; External Oblique Plane Block (EXOP); Postoperative pain; Laparoscopic gynecologic surgery

Outcome Measures

Primary Outcomes (1)

• Postoperative Pain Score (NRS)

  Postoperative pain will be assessed using the Numeric Rating Scale (NRS, 0-10). Pain scores will be recorded at 1, 2, 6, 12, and 24 hours after surgery and will be compared between Group M and Group E. The Numeric Rating Scale ranges from 0 to 10 (0 = no pain, 10 = worst imaginable pain); higher scores indicate worse pain.

  1, 2, 6, 12, and 24 hours after surgery

Secondary Outcomes (2)

• Rescue Analgesic Requirement

  First 24 hours after surgery

• Quality of Recovery (QoR-15 Score)

  Preoperative baseline and postoperative 24th hour

Other Outcomes (3)

• Time to First Rescue Analgesic Request

  First 24 hours after surgery

• Dermatomal Spread (Pinprick Test)

  1, 2, 6, 12, and 24 hours after surgery

• Postoperative Nausea and Vomiting (PONV) Score

  First 24 hours after surgery

Study Arms (2)

Group M

Participants who received a bilateral M-TAPA block performed pre-extubation as part of routine anesthesia practice.

Procedure: Modified Thoracoabdominal Nerve Block Through Perichondrial Approach

Group E

Participants who received a combined bilateral M-TAPA block and external oblique plane (EXOP) block performed pre-extubation as part of routine anesthesia practice.

Procedure: Modified Thoracoabdominal Nerve Block Through Perichondrial Approach And External Oblique Muscle Plane Block

Interventions

Modified Thoracoabdominal Nerve Block Through Perichondrial Approach PROCEDURE

A bilateral modified thoracoabdominal nerve block through the perichondrial approach (M-TAPA) is performed under ultrasound guidance in the supine position prior to extubation as part of routine clinical practice. After aseptic preparation, a linear ultrasound probe is positioned at the level of the 10th rib in the sagittal plane. The needle is advanced to the fascial plane between the internal oblique and transversus abdominis muscles. Following negative aspiration and confirmation of correct plane identification with hydrodissection, 20 mL of 0.25% bupivacaine is injected bilaterally (total volume 40 mL). The procedure is performed by anesthesiologists experienced in gynecologic surgery, without researcher involvement in clinical decision-making

Also known as: M-TAPA Block

Group M

Modified Thoracoabdominal Nerve Block Through Perichondrial Approach And External Oblique Muscle Plane Block PROCEDURE

Following completion of the bilateral M-TAPA block, an external oblique muscle plane (EXOP) block is performed under ultrasound guidance as part of routine clinical practice. The ultrasound probe is positioned over the lateral abdominal wall between the costal margin and iliac crest. After negative aspiration and confirmation of correct plane identification with hydrodissection, 20 mL of 0.125% bupivacaine is injected on each side into the fascial plane superficial to the external oblique muscle (total volume 80 mL).

Also known as: M-TAPA + EXOP Block

Group E

Eligibility Criteria

• Age: 18 Years - 90 Years
• Gender Eligibility Details: Adult female patients undergoing laparoscopic gynecologic surgery.
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adult female patients undergoing laparoscopic gynecologic surgery.

You may qualify if:

• Patients scheduled for laparoscopic gynecologic surgery
• Age 18-90 years
• ASA physical status I-III

You may not qualify if:

• Contraindications to block procedures (coagulopathy, anticoagulant therapy, local infection at needle insertion site, etc.)
• Severe cardiac, renal, hepatic, hematologic, neurologic, or psychiatric disease
• Allergy to amide-type local anesthetics
• Chronic pain, narcotic or alcohol dependence
• BMI ≥ 35 kg/m²
• Pregnancy
• Refusal to participate
• Conversion from laparoscopy to laparotomy

Sponsors & Collaborators

• Bakirkoy Dr. Sadi Konuk Research and Training Hospital: lead

Study Sites (1)

SBÜ Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi

Istanbul, Bakirkoy, 34147, Turkey (Türkiye)

RECRUITING

Related Publications (4)

• Liu S, Wang Z, Long X, Fleishman A, Huang X, Wu Q, Gershman B, Olumi AF. Single black men have the worst prognosis with localized prostate cancer. Can J Urol. 2022 Feb;29(1):10992-11002.

  PMID: 35150221 BACKGROUND

• Tulgar S, Selvi O, Thomas DT, Deveci U, Ozer Z. Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides effective analgesia in abdominal surgery and is a choice for opioid sparing anesthesia. J Clin Anesth. 2019 Aug;55:109. doi: 10.1016/j.jclinane.2019.01.003. Epub 2019 Jan 9. No abstract available.

  PMID: 30639940 BACKGROUND

• Atsumi C, Aikawa K, Takahashi K, Okada K, Morimoto Y. The comparison of postoperative analgesic requirements between modified thoracoabdominal nerve block through perichondrial approach versus wound infiltration analgesia in patients undergoing gynecological laparoscopic surgery: a retrospective, exploratory study. JA Clin Rep. 2023 Jun 24;9(1):39. doi: 10.1186/s40981-023-00632-w.

  PMID: 37354282 BACKGROUND

• Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017 Sep 25;10:2287-2298. doi: 10.2147/JPR.S144066. eCollection 2017.

  PMID: 29026331 BACKGROUND

MeSH Terms

Conditions

Pain, Postoperative

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Central Study Contacts

Şeyma Nur Güner Zengin, MD

CONTACT

+90 212 414 71 71; snurguner@gmail.com

Güneş Özlem Yıldız, Associate Professor

CONTACT

+90 212 414 71 71; drgunesim@hotmail.com

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor, Principal Investigator

Study Record Dates

• First Submitted: November 24, 2025
• First Posted: December 4, 2025
• Study Start: November 25, 2025
• Primary Completion (Estimated): October 1, 2026
• Study Completion (Estimated): October 1, 2026
• Last Updated: January 6, 2026

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)