Comparision of Analgesic Efficacy of Tap Block With Parentral Opioid Following Total Abdominal Hysterectomy

Abstract

OBJECTIVE: Our study aims to evaluate the efficacy of ultrasound guided TAB in postoperative pain relief in a cohort of patients undergoing total abdominal hysterectomy by comparing it with patients who do not receive TAB. The primary end point studied was total 24 hour morphine consumption. The secondary objectives measured were postoperative heart rate, systolic & diastolic blood pressure, respiratory rate, postoperative pain score, nausea, vomiting and sedation score. STUDY DESIGN:Forty patients of ASA I aged 30 to 60 years scheduled for total abdominal hysterectomy surgery in Amala Institute of Medical Sciences, Kerala, India were included in this prospective cohort study. Study duration was for 15 months. First 20 consecutive patients satisfying the inclusion criteria and who received ultrasound guided transverses abdominis block with 15 ml of 0.25% bupivacaine on each side was designated as TAB group. The first 20 patients satisfying inclusion criteria and who did not receive TAB were designated as Non-TAB group. The relevant data of each patient were recorded and the results were statistically analyzed. RESULTS:Patients who received transverses abdominis block with bupivacaine had significantly reduced 24 h morphine requirements in milligrams (TAB group 6.75±2.45, Non-TAB group 12.00±2.51, p value<0.01). The mean time (in hours) to first request for morphine was significantly longer in patients who received transverses abdominis block (TAB group 5.8±2.97, Non-TAB group 1.93±1.17, p value<0.01). There was significant difference in the pain scores at the end of first postoperative hour, with patients without TAB complained of significant pain at rest, cough and movement. At all other time intervals in the first 24hrs the pain scores were higher in the non-TAB group but not significantly different. But pain requiring rescue analgesic (>3) was significantly higher in non-TAB group. CONCLUSIONS:In conclusion we found that ultrasound guided transverses abdominis block provided substantial reduction in morphine consumption when compared with control group. TAB also reduced significantly the time to first dose of rescue morphine. The technique is found to be safe and effective. The study reinforces the recommendation for TAB as a part of multimodal post-operative analgesic regimen.