The effectiveness of M-TAPA on pain management and quality of recovery after cesarean section: A prospective randomized- controlled study
Abstract
Objective: Moderate-to-severe pain is a common complaint after cesarean section (C/S) and may adversely affect the recovery and well-being of both the mother and the newborn. This prospective randomized controlled trial aimed to determine whether ultrasound-guided modified thoracoabdominal nerve block via the perichondral approach (M-TAPA) improves postoperative analgesia and quality of recovery after cesarean section.
Methods: This single-center study included pregnant women scheduled for elective cesarean section, beyond the 37th week of gestation, with American Society of Anesthesiologists (ASA) physical status II. Participants were randomly allocated to the M-TAPA group or the control group. Postoperative pain was assessed using the numeric rating scale (NRS), and quality of recovery was assessed using the 15-item Quality of Recovery Scale (QoR-15). Primary and secondary outcomes were statistically compared between groups.
Results: Patients who received M-TAPA showed significantly lower pain scores than the control group at rest and with movement at postoperative hours 2, 4, 8, and 16 (p < 0.05); however, NRS values at postoperative hour 24 were similar between groups. Opioid consumption was similarly reduced, and QoR-15 scores were higher in the M-TAPA arm compared with the control group (p = 0.001).
Conclusion: M-TAPA provides effective analgesic management after cesarean section. M-TAPA is important for supporting recovery and reducing opioid requirements, thereby improving outcomes in women undergoing cesarean section.
Trial Registration: The study was registered at ClinicalTrials.gov (ID: NCT06078475).Keywords
References
Visser GHA, Ayres-de-Campos D, Barnea ER, de Bernis L, Di Renzo GC, Vidarte MFE, et al. FIGO position paper: how to stop the caesarean section epidemic. Lancet. 2018;392(10155):1286-7. https://doi.org/10.1016/S0140-6736(18)32113-5
Roofthooft E, Joshi GP, Rawal N, Van de Velde M; PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy and supported by the Obstetric Anaesthetists’ Association. PROSPECT guideline for elective caesarean section: updated systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2021;76(5):665-80. https://doi.org/10.1111/anae.15339
Gamez BH, Habib AS. Predicting severity of acute pain after cesarean delivery: a narrative review. Anesth Analg. 2018;126(5):1606-14. https://doi.org/10.1213/ANE.0000000000002658
Kainu JP, Halmesmäki E, Korttila KT, Sarvela PJ. Persistent pain after cesarean delivery and vaginal delivery: a prospective cohort study. Anesth Analg. 2016;123(6):1535-45. https://doi.org/10.1213/ANE.0000000000001619
Sutton CD, Carvalho B. Optimal pain management after cesarean delivery. Anesthesiol Clin. 2017;35(1):107-24. https://doi.org/10.1016/j.anclin.2016.09.010
Tulgar S, Senturk O, Selvi O, Balaban O, Ahiskalioğlu A, Thomas DT, et al. Perichondral approach for blockage of thoracoabdominal nerves: anatomical basis and clinical experience in three cases. J Clin Anesth. 2019;54:8-10. https://doi.org/10.1016/j.jclinane.2018.10.015
Tulgar S, Selvi O, Thomas DT, Deveci U, Özer 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;55:109. https://doi.org/10.1016/j.jclinane.2019.01.003
de Oliveira EJSG, De Lima RC, Sakata RK, Freire TT, de Almeida Lima EL, de Oliveira CMB, et al. Modified thoracoabdominal nerve block through the perichondral approach (M-TAPA) in laparoscopic sleeve gastroplasty: a case series. Obes Surg. 2022;32(1):197-201. https://doi.org/10.1007/s11695-021-05612-6
Ohgoshi Y, Ando A, Kawamata N, Kubo EN. Continuous modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) for major abdominal surgery. J Clin Anesth. 2020;60:45-6. https://doi.org/10.1016/j.jclinane.2019.08.031
Altıparmak B, Korkmaz Toker M, Uysal Aİ, Turan M, Gümüş Demirbilek S. The successful usage of modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) for analgesia of laparoscopic ventral hernia repair. J Clin Anesth. 2019;57:1-2. https://doi.org/10.1016/j.jclinane.2019.02.016
Aikawa K, Tanaka N, Morimoto Y. Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides a sufficient postoperative analgesia for laparoscopic sleeve gastrectomy. J Clin Anesth. 2020;59:44-5. https://doi.org/10.1016/j.jclinane.2019.06.020
Myles PS, Shulman MA, Reilly J, Kasza J, Romero L. Measurement of quality of recovery after surgery using the 15-item quality of recovery scale: a systematic review and meta-analysis. Br J Anaesth. 2022;128(6):1029-39. https://doi.org/10.1016/j.bja.2022.03.009
Burns D, Perlas A. Regional anaesthesia and quality of recovery after surgery. Anaesthesia. 2020;75(5):576-9. https://doi.org/10.1111/anae.14980
Myles PS, Boney O, Botti M, Cyna AM, Gan TJ, Jensen MP, et al.; StEP–COMPAC Group. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: patient comfort. Br J Anaesth. 2018;120(4):705-11. https://doi.org/10.1016/j.bja.2017.12.037
Kara U, Şimşek F, Kamburoğlu H, Özhan MÖ, Alakuş Ü, İnce ME, et al. Linguistic validation of a widely used recovery score: quality of recovery-15 (QoR-15). Turk J Med Sci. 2022;52(2):427-35. https://doi.org/10.55730/1300-0144.5330
Republic of Türkiye Ministry of Health, General Directorate of Health Information Systems. Health statistics yearbook 2022: news bulletin [Internet]. Ankara: Republic of Türkiye Ministry of Health; 2023 [cited 2026 Oct 20]. Available from: https://dosyamerkez.saglik.gov.tr/Eklenti/46511/0/haber-bulteni-2022-v7pdf.pdf
European Society of Regional Anaesthesia and Pain Therapy (ESRA). PROSPECT publications on caesarean section [Internet]. ESRA; 2020 [updated 2023] [cited 2026 Oct 18]. Available from: https://esraeurope.org/prospect/procedures/caesarean-section-2020/prospect-publication-caesarean-section/
Ciftci B, Alici HA, Ansen G, Sakul BU, Tulgar S. Cadaveric investigation of the spread of the thoracoabdominal nerve block using the perichondral and modified perichondral approaches. Korean J Anesthesiol. 2022;75(4):357-9. https://doi.org/10.4097/kja.22137
Çiftçi B, Güngör H, Alver S, Akın AN, Özdenkaya Y, Tulgar S. Clinical experience for modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) in five patients. Dermatomal evaluation and application of different volumes: a case series and review of literature. Turk J Anaesthesiol Reanim. 2023;51(4):354-7. https://doi.org/10.4274/TJAR.2022.221042
Sawada A, Kumita S, Nitta A, Ohsaki Y, Yamakage M. Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA): an anatomical study to evaluate the spread of dye after a simulated injection in soft embalmed Thiel cadavers. Reg Anesth Pain Med. 2023;48(8):403-7. https://doi.org/10.1136/rapm-2022-104275
Alver S, Ciftci B, Güngör H, Gölboyu BE, Ozdenkaya Y, Alici HA, et al. Efficacy of modified thoracoabdominal nerve block through perichondrial approach following laparoscopic inguinal hernia repair surgery: a randomized controlled trial. Braz J Anesthesiol. 2023;73(5):595-602. https://doi.org/10.1016/j.bjane.2023.05.001
Ohgoshi Y, Anetai H, Hanai S, Ichimura K, Kawagoe I. The key to success in blocking lateral cutaneous branches with re-modified thoracoabdominal nerves block through perichondrial approach: a newly discovered space between the endothoracic fascia, diaphragm, and costodiaphragmatic recess. J Anesth. 2024;38(5):642-9. https://doi.org/10.1007/s00540-024-03366-w
Murata H. Beyond "re-modified TAPA": advocating for the SEDIC block to standardize nomenclature. J Anesth. 2026;40(3):331-3. https://doi.org/10.1007/s00540-025-03642-3
Tanaka N, Suzuka T, Kadoya Y, Okamoto N, Sato M, Kawanishi H, et al. Efficacy of modified thoracoabdominal nerves block through perichondrial approach in open gynecological surgery: a prospective observational pilot study and a cadaveric evaluation. BMC Anesthesiol. 2022;22(1):107. https://doi.org/10.1186/s12871-022-01652-2
Bilge A, Başaran B, Et T, Korkusuz M, Yarımoğlu R, Toprak H, et al. Ultrasound-guided bilateral modified-thoracoabdominal nerve block through a perichondrial approach (M-TAPA) in patients undergoing laparoscopic cholecystectomy: a randomized double-blind controlled trial. BMC Anesthesiol. 2022;22(1):329. https://doi.org/10.1186/s12871-022-01866-4
Bilge A, Başaran B, Altıparmak B, Et T, Korkusuz M, Yarımoğlu R. Comparing ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach with oblique subcostal transversus abdominis plane block for patients undergoing laparoscopic cholecystectomy: a randomized, controlled trial. BMC Anesthesiol. 2023;23(1):139. https://doi.org/10.1186/s12871-023-02106-z
Ozen V, Acik ME, Ozen N. The modified thoracoabdominal nerve block for post-operative analgesia in paediatric laparoscopic cholecystectomy. J Minim Access Surg. 2024;20(4):452-5. https://doi.org/10.4103/jmas.jmas_174_22
