Background: The study was done to assess postoperative analgesic efficacy of ultrasound guided continous transverses abdominis plane block, continuous lumbar paravertebral block and continuous lumbar epidural block in patients undergoing lower abdominal surgeries (unilateral inguinal hernia repair). We compared their analgesic efficacy over the first 48 hour postoperative, in a randomized, single blind study in 120 patients divided in four equal groups, 30 patients in each group.
Methods: 120 patients were randomly assigned into four equal groups, 30 patients in each group. Group T received ultrasound guided transverses abdominis plane block with 20 ml of bupivacaine 0.25% followed by continuous infusion of bupivacaine 0.125% (0.1 ml / kg / hr) and group P received ultrasound guided continuous lumbar peravertebral block with bupivacaine 0.25% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.125% (0.1 ml / kg/hr). Group E received continuous lumbar epidural analgesia with bupivacaine 0.25 bolus dose 20ml, followed by continous infusion of bupivacaine 0.125% (0.1 ml / kg / hr) and group C received normal saline bolus dose 20 ml, followed by continuous infusion of normal saline (0.1 ml / kg/hr). General anesthesia was induced with fentanyl 1-2 g/kg and propofol 1 – 3 mg/kg followed by atracurium 0.5 mg/kg. at end of surgical procedure, we activate regional block with recording of parameters in the postoperative period each patient was assessed for visual analogue scale (VAS) at rest and on movement, analgesic consumption, vital signs and presence of complications (nausea, vomiting, sedation), and postoperative patient satisfaction all data collected postoperatively by a blinded investigator at one, two, 6, 12, 24 and 48 hours postoperatively.
Results: Postoperative analgesic efficacy is more in group E than group P and group T, the latter is least effective in pain control. Also in group E the postoperative analgesic consumption is lower than in group P and group T. Regarding complications as nausea and vomiting were more recorded in epidural than other two groups.
Conclusion: Regarding postoperative analgesic efficacy, continuous lumbar epidural block is more effective than continuous paravertebral and continuous transverses abdominis plane block, but regarding complications, there were higher incidence in epidural group than other two groups.
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