Analgesic Efficacy of Ultrasound-guided Lateral Transversus Abdominis Plane Block in Patients Who Underwent General Gynecologic Surgery via Lower Abdominal Skin Incisions: A Randomized Controlled Trial

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Wachiraporn Phooripoom

Abstract

Background: Severe postoperative pain is usually seen as a major problem caused by lower abdominal incisions. Therefore, we should combine various anesthetic techniques, especially the injection of anesthesia into peripheral nerves regarded as ultrasound-guided lateral transversus abdominis plane block (TAPB), to efficiently reduce postoperative pain.
Objective: To evaluate the analgesic efficacy of ultrasound-guided lateral transversus abdominis plane block in patients undergoing general gynecologic surgery via lower abdominal skin incisions and the reduction in amount of postoperative intravenous morphine used.
Methods: A randomized single-blinded study was conducted in patients who underwent general gynecologic surgery via lower abdominal skin incisions (total abdominal hysterectomy, myomectomy, salpingo-oophorectomy) under general anesthesia during January 2018 to January 2019. 70 patients were randomly assigned using a computer software into either a control group or an experimental group, which labeled privately in sealed envelopes. The control group received the standard of care treatment and intravenous patient-controlled analgesia (IV-PCA) postoperatively as analgesic, whereas the TAPB group was added postoperatively with bilateral ultrasound-guided TAPB using 20 ml of 0.25% bupivacaine on each side. Data was collected at 1, 2, 4, 6, 24 postoperative hours during the patients stay in Postanesthetic care unit (PACU) and regular wards regarding the numeric rating scale (NRS) of pain both at rest and on activity, the amount of morphine consumptions, and other complications. All clinical data was assessed by a blinded investigator.
Results: The ultrasound-guided TAP block significantly reduced pain intensity compared to the control group at 1 postoperative hour (at rest 3.5 ± 2.6 vs 5.1 ± 2.4, P=0.007, on activity 4.2 ± 2.8 vs 6.0 ± 2.4, P=0.006) and at 4 postoperative hours (at rest 4.3 ± 1.4 vs 5.5 ± 1.6, P=0.002, on activity 5.2 ± 1.6 vs 6.2 ± 1.7, P=0.011). Total morphine requirements at ward were significantly reduced (23.9 ± 9.7 vs 38.4 ± 11.6 mg, P=<0.001).
Conclusion: After undergoing general gynecologic surgery via a lower abdominal skin incision, the ultrasound-guided TAP block using 20 ml of 0.25% bupivacaine on each side significantly reduces the pain intensity and postoperative morphine consumptions during 24 postoperative hours.
Keywords: Ultrasound-Guided Transversus Abdominis Plane Block, General Gynecologic Surgery, Postoperative Morphine Consumptions

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