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

Abstract

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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References

1. สหัทยา ไพบูลย์วรชาติ. ความปวดและการประเมินความปวด.[อินเทอร์เน็ต]. กรุงเทพฯ:คณะแพทยศาสตร์ จุฬาลงกรณ์มหาวิทยาลัย;2555 [เข้าถึงเมื่อ 1 ต.ค.2560]. เข้าถึงได้จาก: https://www.google.co.th/url?url=https://www.med.cmu.ac.th/dept/anes/2012/images/Lecture2015/PharmacologicPain.pdf&rct

2. Good M, Hicks MS, Grass JA, Anderson CG, Makii M, Geras J. Pain after gynecologic surgery. Pain management nursing. 2000;1(3):96-104
.
3. Karim Mukhtar. Tranversus abdominis plane (TAP) block. The Journal of NYSORA. 2009;12:28-33.

4. Gray H. The Anatomy Basic of Clinical Practice, 40th.ed. Philadelphia : Churchill-Livingstone Elsevier; 2008:1576.

5. Paul Townsley, James French. Transversus abdominis plane block Anesthesia Tutorial of the week 239 [serial online] 2011 5th. september 2011 [cited 2017 1st.Oct.];2011:[12 screens]. Available from : URL: https://www.frca.co.uk/Documents/239%20Transversus%20Abdominus%20Plane%20Block%20.pdf

6. Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anesthesia Intensive Care. 2007;35(4):616-7.

7. Belavy D, Cowlishaw PJ, Howes M, Phillips F. Ultrasound-guided transversus abdominis plane block for analgesia after Caesarean delivery. Br J Anaesth. 2009;103(5):726- 30.

8. Gasanova I, Grant E, Way M, Rosero EB, Joshi GP. Ultrasound-guided transversus abdominis plane block with multimodal analgesia for pain management after total abdominal hysterectomy. Arch Gynecol Obstet. 2013;288:105-11.

9. McDonnell JG, O’Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg. 2007;104:193-7.

10. Charlton S, Cyna AM, Middleton P, Griffiths JD. Perioperative transversus abdominis plane (TAP) block for analgesia after abdominal surgery. Cochrane Database Syst Rev. 2010;8(12):CD007705.

11. Carney J, McDonnell J, Ochana A, Bhinder R, Laffey J. The transversus abdominis plane block provide effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg. 2008;107(6):2056-60.

12. Ghisi D, Fanelli A, Vianello F, Gardini M, Mensi G, La colla L, Danelli G. Tranversus abdominis plane block for postoperative analgesia in patients undergoing total laparoscopic hysterectomy: A randomized, controlled, observer-blinded trail. Anesth Analg. 2016;123(2):488-92.

13. De Oliveira GS Jr, Castro-Alves LJ, Nader A, Kendall MC, McCarthy RJ. Transversus abdominis plane block to ameliorate postoperative pain outcomes after laparoscopic surgery: a meta-analysis of randomized controlled trials. Anesth Analg. 2014;118(2):454-63.

14. Bonnet F, Berger J, Aveline C. Transversus abdominis plane block: what is its role in postoperative analgesia? Br J Anaesth. 2009;103(4):468-70.

15. Petersen PL, Mathiesen O, Tourup H, Dahl JB. The transversus abdominis plane block: a valuable option for postoperative analgesia? A topical rewiew. Acta Anaesthesiol Scand. 2010;54(5):529-35.

16. Stanley G, Appadu B, Mead M, Rowbotham DJ. Dose requirements, efficacy and side effects of morphine and pethidine delivered by patient-controlled analgesia after gynaecological surgery. Br J Anaesth. 1996;76(4):484-6.

17. Woodhouse A, Mather LE. The effect of duration of dose delivery with patient-controlled analgesia on the incidence of nausea and vomiting after hysterectomy. Br J Clin Pharmacol. 1998;45(1):57-62.

18. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91(3):693-700.

19. Ng A, Swami A,Smith G, Davidson AC, Emembolu J. The analgesia effects of intraperitoneal and incisional bupivacaine with epinephrine after total abdominal hysterectomy. Anesth Analg. 2002;95(1):158-62.

20. Gupta A, Perniola A, Axelsson K, Thorn SE, Crafoord K, Rawwal N. Postoperative pain after abdominal hysterectomy: A double-blind comparison between placebo and local anesthetic infused intraperitonealli. Anesth Analg. 2004;99(4):1173-9.

21. Elvir-Lazo OL, White PF. Postoperative pain management after ambulatory surgery: role of multimodal analgesia. Anesthesiol Clin. 2010;28(2):217-24.

22. McDonnell JG, Curley G, Carney J, Benton A, Costello J, Maharaj CH, [et.al] The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg. 2008;106(1):186-91.

23. Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change score: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003;4(7):407-14.

24. อรุโณทัย ศิริอัศวกุล, นฤนาท โลมะรัตน์, น้ำทิพย์ ไตรยสุนันท์, วิมลลักษณ์ สนั่นศิลป์, ภูษิตา สำราญกิจดำรง และคณะ. ความชุกและปัจจัยที่มีผลต่อความปวดภายใน 24 ชั่วโมงในผู้ป่วยที่ได้รับการตัดมดลูก. วิสัญญีสาร. 2555;38(2):118-29.

25. Grantcharov TP, Rosenberg J. Vertical compared with transverse incisions in abdominal surgery. Eur J Surg. 2001;167(4):260-7.

26. Cervero F, Laird JM. Visceral pain. Lancet. 1999;353(9170):2145-8.

27. Tran TM, Ivanusic JJ, Hebbard P, Barrington MJ. Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study. Br J Anaesth. 2009;102(1):123-7.

28. Zoka M, Tabor D, Mcconnell P, Pickering J. Large volume dye spread in transversus abdominis plane block via three injection sites : a cadaveric study. Periodicum Biologorum. 2011;113(2):203-6.

29. ปรางค์มาลี ลือชารัศมี. ยาชา[อินเทอร์เน็ต]. ภาควิชาวิสัญญีวิทยา คณะแพทยศาสตร์ มหาวิทยาลัยเชียงใหม่; 2559. [เข้าถึงเมื่อ 1 ต.ค. 2560]. เข้าถึงได้จาก: www.med.cmu.ac.th/dept/anes/2012/images/Lecture2015/LocalAnesthetics2559.pdf