Abstract
A modified thoracoabdominal nerve block through the perichondrial approach (M-TAPA) effectively blocks the anterior and lateral cutaneous branches of the Th5-12 thoracoabdominal nerves. A new method was devised for puncturing parallel to the costal cartilage by rotating the echo probe by 90°. This study presents two patients who underwent M-TAPA for surgical intervention: laparoscopic vaginal total hysterectomy and open adnexal resection. Case 1 involved a 49-year-old woman who underwent laparoscopic surgery and was bilaterally injected with 0.25% levobupivacaine, which successfully relieved pain and minimal postoperative complaints. Case 2 was a 38-year-old woman who underwent open adnexal resection, was bilaterally administered 0.2% levobupivacaine, and experienced effective pain management for laparotomy. Postoperative analgesia was managed with intravenous acetaminophen and fentanyl in both patients. Our approach is useful because the block was performed with a view similar to that of the existing transversus abdominis plane block under the costal arch and needle visibility was improved by placing the probe parallel to the costal cartilage. Our approach is as effective as the conventional block for lower abdominal surgery.