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Category: Volume 07 Issue 10 October 2019
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Title: Evaluation of Effectiveness of the Transversus Abdominis Plane Block to Provide Effective Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy

Authors: Dr Asmita Bhalke, Dr Minakshi Chole, Dr Abhimanyu Tarkase

 DOI: https://dx.doi.org/10.18535/jmscr/v7i10.43

Abstract

  

Introduction: Total abdominal hysterectomy (TAH) is one of the most common surgery performed in gynecology. Transversus Abdominis Plane (TAP) block as a part of multimodal anesthesia is being increasingly used in patients undergoing total abdominal hysterectomy for benign as well as malignant conditions. It is easy to perform, technically simple, pharmacologically safe, effective and economically cheap. TAP block is a part of multimodal analgesic regimen and improved analgesia, decreased opioid consumption and its side effect during postoperative period. The purpose of this study was to evaluate effectiveness of TAP block to provide effective postoperative analgesia in patients undergoing total abdominal hysterectomy.

Materials and Methods: This was a prospective case control study of 100 patients undergoing total abdominal hysterectomy under TAP block. The institutional ethical committee approved the study and an informed written consent was obtained from all the patients. The patients were included in this study on the basis of a predefined inclusion and exclusion criteria. Amongst 100 cases included in this study 50 patients were given USG guided TAP block with ropivacaine (n =50) [TAP BLOCK GROUP] versus placebo (n=50) [CONTROL GROUP]. All patients underwent routine investigations such as complete blood count, coagulation profile, bleeding time, clotting time, ECG, LFT and KFT. If indicated further investigations were done in selected cases. Perioperative and postoperative hemodynamic parameters, VAS scores, ETCO2 levels requirement of rescue analgesia, Mean sedation scores and incidence of Post-operative nausea and vomiting (PONV) were compared in both the groups. P value less than 0.05 was taken as statistically significant.

Results: Mean age, height, weight and duration of surgery in both the groups were found to be comparable. The control group was found to have a higher heart rate, systolic BP, Diastolic BP and mean arterial pressures  as compared to TAP block group at 5,10,15,20,30,40,50,60,75 and 90 minutes as well as in postoperative period and the difference was found to be statistically “highly significant” (P<0.0001). The analysis of VAS scores of the patients in post-operative period showed that Median VAS score at 1st hour was 3.0 (3.0, 3.0) and 5.0 (5.0, 6.0) in TAP block group and Control group respectively and the difference was statistically significant. (p<0.0001). Mean dose of RA required in 24-hour postoperative period was significantly lesser with TAP block than control group (54.5±4.0 Vs234.9±31.4, p<0.0001).

Conclusion: TAP Block is associated with better hemodynamic stability, better pain control, lesser need of rescue analgesia and better sedation scores making it promising technique in alleviating postoperative pain in patients undergoing lower abdominal gynecological surgeries particularly when used as part of multi-modal analgesia regimen.

Keywords: Hysterectomy, Transversus Abdominis Plane (TAP) block, Hemodynamic Stability, Rescue analgesia.

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Corresponding Author

Dr Minakshi Chole

Senior Resident, Department of Anesthesiology, Dr. Shankerrao Chavan Government Medical College, Nanded, India