Comparison of Local Anesthetic Wound Infiltration Versus Transversus Abdominis Plane Block In Patients Undergoing Total Abdominal Hysterectomy

Yasmeen Afridi, Naheed Fatima, Suresh Kumar, Iqbal Memon, Ishtiaq Anwar

Abstract

Objective

To compare the analgesic effectiveness of local wound infiltration versus transversus abdomenis plane (TAP) block after total abdominal hysterectomy (TAH).

Study design

Experimental study.

Place & Duration of study

Department of Anaesthesiology, Pakistan Institute of Medical Sciences (PIMS) Islamabad, from June 2014 to August 2015.

Methodology•

Sample size of 52 patients was calculated using WHO calculator. Non probability consecutive sampling was used for patients’ selection. Ethical approval was taken from ethical review board of PIMS. Patients were randomly divided into two groups using computer generated random number. Group A was given local anaesthetic infiltration with 0.6ml/kg of 0.25% bupivacaine and Group B was given transverse abdominal plane block (TAP) bilaterally with 18G needle piercing cephalic to iliac crest skin for about 2 inches. Data was analysed using SPSS version 22. Student t test was applied and p  <0.05 was considered significant.

Results

Total of 52 patients were included in the study with 1:1 randomization (26 patients in each group). There were 30 (58%) males and 22 (42%) females. Mean age of patients was 44.4±7.3 year. Significantly longer T rescue time was noted in TAP block (148±46.7 minutes) as compared to infiltration (85.3±38 minutes - p=0.003).  Significantly lower mean pain scores were reported in TAP block (4.12±1.4) as compared infiltration (5.58±1.98 - p=0.001). Sedation was found better in TAP block as compared to infiltration (p<0.05).

Conclusions

TAP block is an effective multimode analgesic in terms of pain reduction, sedation and T rescue after total abdominal hysterectomy. The process is reliable, easy to perform and provide effective analgesia. No complications and side effects were reported with TAP block.

Key words

Hysterectomy, TAP block, Analgesic-postoperative.