Aim: to compare bilateral ultrasound guided transversus abdominis
plane (TAP) block with single – shot – local anesthetic subcutaneous
and sub facial wound infiltration (LWI) for analgesia after total
abdominal hysterectomy (TAH) under general anesthesia.
Patients and methods: This prospective randomized, parallel group,
concealed allocation, patients and observers blinded superiority trial,
conducted at Benha University Hospital, including 87 women
undergoing TAH, 43 women received 40 ml 0.25 bupivacaine as
bilateral ultrasound guided TAP block and 44 women received 40 ml,
0.25% bupivacaine as subcutaneous and sub facial local wound
infiltration at the end of TAH performed under general anesthesia.
Main outcomes were total cumulative Nalbuphine consumption and
post TAH pain at rest and with movement using visual analogue scale
(VAS) as well as incidence of nausea, vomiting, other analgesic
requirements, time spent in post anesthesia care unit (PACU), time to
get out of bed, deepest sedation, patient satisfaction regards analgesia
in First 24 hour postoperative.
Results: Total Nalbuphine consumption were significantly lower in
TAP block group at 2, 4, 8, 12, 24 hours and at discharge (P < 0.0001).
The mean post TAH pain VAS score both at rest and on movement
were significantly lower in TAP block group at PACU, 2h, 8h, 12h (P <
0.05) as well as at 4h on movement (P < 0.05). Also, total non-steroidal
anti-inflammatory drugs (NSAIDs) consumption were lower in TAP
block up to twenty-four hours postoperatively (P < 0.005), time to get
out of bed (P = 0.03) and time to first flatus (P = 0.0002).
Conclusion: Bilateral ultrasound guided TAP block is superior to local
anesthetic wound infiltration in analgesia for post TAH pain as Tap
block was associated with reduced both rest and on movement
postoperative pain and total cumulative opioids analgesia as well as
promotes early mobilization and gut recovery. |
