Analgesic Effect of Ultrasound-guided Transversus Abdominis Plane Block with Bupivacaine 0.25% in Patients Undergoing Total Abdominal Hysterectomy: Prospective Randomized Controlled Trial Study

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Atchara Butdawong Amara Leesan Sarinra thongmee


Background: Total abdominal hysterectomy (TAH) is a commonly performed major surgical procedure, after which substantial postoperative discomfort and moderate to severe pain intensity, transversus abdominis plane (TAP) block has been suggested as an adjunct in multimodal analgesia regimen.
Objective: Primary outcome was the 24 hours postoperative morphine consumption. Secondary outcomes were pain scores at rest and during movement, postoperative nausea and vomiting at 1, 2, 6, 12 and 24 hours, sedation scores , discomfort scores and complications from TAP block.
Method: 38 patients who scheduled for abdominal hysterectomy via a low midline incision and Pfannensteil incision under general anesthesia were randomized to undergo bilateral ultrasound-guided TAP block with bupivacaine 0.25% (n=19) Versus placebo (n=19) on each side. They are allowed to use acetaminophen, non-steroidal anti-inflammatory drugs, and patient controlled analgesia (PCA) after surgery. Each patient was assessed 24 hours after surgery for morphine consumption, pain, discomfort score, nausea, vomiting, pruritus and complication from TAP block at 1, 2, 6, 12 and 24 hours.
Results: Ultrasound-guided TAP block did not reduced morphine consumption and numeric rating scale during the first postoperative 24 hours after elective total abdominal hysterectomy, did not reduced nausea and vomiting, pruritus, sedation scores and discomfort scores when compared with placebo block. There were no complications attributable to the TAP block. Conclusion: The ultrasound-guided TAP block with bupivacaine 0.25% did not reduced morphine consumption and numeric rating scale during the first postoperative 24 hours after elective total abdominal hysterectomy.
Keywords: transversus abdominis plane block, postoperative morphine consumption, abdominal hysterectomy.


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