Analgesic efficacy of preoperative ultrasound transversal abdominal plane block for open hysterectomy

Abstract

Transversus abdominis plane (TAP) block is a promising technique in post-operative pain relief, following various types of surgeries with an incision on the anterio-lateral abdominal wall. Our randomized, prospective, control trial evaluates its peri-operative analgesic effectiveness for total abdominal hysterectomy (AH) via Pfannenstiel approach. Forty-six women, admitted for intervention, were randomized. A group with an application of bilateral, preincisional TAP block with ropivacaine (n = 23) versus a control group (n = 23) were formed. The post-operative pain relief for all the participants consisted of a mono-component, patient-controlled morphine analgesia. The amount of total 24 h morphine consumption and intraoperative fentanyl use was calculated. Pain at rest and in motion was assessed on a Verbal Numeric Scale (VNS). The incidence of post-operative nausea and vomiting was registered. TAP block with ropivacaine reduced the 24 h post-operative cumulative morphine requirements. The morphine consumption of the TAP block group (14.5 mg ± 4 mg) was statistically significantly lower than the control one (21.7 mg ± 6.8 mg). TAP block decreased the intraoperative use of fentanyl and the post-operative VNS scores at rest and in motion. The groups did not demonstrate any difference in the incidence of nausea and vomiting after surgery. TAP block was not associated with any complications. Our study showed that TAP block effectively leads to superior analgesia in patients undergoing total AH.