Transversus Abdominis Plane Block Versus Local Wound Infiltration for Postoperative Pain Management in Patient Undergoing Total Abdominal Hysterectomy
Keywords:
Analgesia, Hysterectomy, Postoperative Pain, Visual Analogue ScaleAbstract
Objective: To compare the outcomes of transversus abdominis plane (TAP) block versus local wound infiltration (LAI) for postoperative analgesia in patients undergoing total abdominal hysterectomy (TAH).
Methods: This randomized controlled trial was conducted at Dr. Ziauddin Hospital & Medical College, Karachi, Pakistan from December 2023 to May 2024. Female patients aged 18 to 50 years, and scheduled for TAH under general anesthesia were included. Patients were randomly allocated to the TAP group or the LAI group using sealed opaque envelopes. The primary outcome was pain score at different time intervals postoperatively. Pain score measured using the Visual Analogue Scale. Secondary outcomes included total analgesia consumption within 24 hours.
Results: Of total 100 patients, the median (IQR) age was 50.0 (47.2-55.0) years. At 8 hours postoperatively, the median pain score was significantly lower in the TAP group 0.0 (0.0-1.0) compared to the LAI group 1.0 (0.0-2.0) (p-value <0.001). Similarly, at 12 hours, the TAP group reported a median pain score of 2.0 (1.0-2.0), significantly lower than the LAI group 3.0 (2.0-4.0) (p-value <0.001). At 24 hours, the median pain score remained significantly lower in the TAP group 50.0 (50.0-70.0) compared to the LAI group 130.0 (120.0-140.0) (p-value <0.001). Total analgesia consumption was also significantly lower in TAP group as compared to LAI group i.e., 50.0 (50.0-70.0) vs. 130.0 (120.0-140.0) (p-value <0.001).
Conclusion: The TAP block provided superior postoperative pain control compared to LAI in patients undergoing TAH, evidenced by lower pain scores and reduced analgesia consumption.
Downloads
References
Pirie K, Traer E, Finniss D, Myles PS, Riedel B. Current approaches to acute postoperative pain management after major abdominal surgery: a narrative review and future directions. Br J Anaesth 2022; 29:378-93. doi:10.1016/j.bja.2022.05.029
Afshan G, Khan RI, Ahmed A, Siddiqui AS, Rehman A, Raza SA, et al. Post-operative pain management modalities employed in clinical trials for adult patients in LMIC: A systematic review. BMC Anesthesiol 2021; 21:160. doi:10.1186/s12871-021-01375
Jin Z, Lee C, Zhang K, Gan TJ, Bergese SD. Safety of treatment options available for postoperative pain. Expert Opin Drug Saf 2021; 20:549-59. doi:10.1080/14740338.2021.1898583
Olausson A, Svensson CJ, Andrell P, Jildenstal P, Thorn SE, Wolf A. Total opioid-free general anaesthesia can improve postoperative outcomes after surgery, without evidence of adverse effects on patient safety and pain management: A systematic review and meta-analysis. Acta Anaesthesiol Scand 2022; 66:170-85. doi:10.1111/aas.13994
Penuela L, DBrass TJ, Tubog TD. Use of transversus abdominis plane block in hysterectomy: A systematic review. J Perianesth Nurs 2023; 38:331-8. doi:10.1016/j.jopan.2022.06.017
Peltrini R, Cantoni V, Green R, Greco PA, Calabria M, Bucci L, et al. Efficacy of transversus abdominis plane (TAP) block in colorectal surgery: A systematic review and meta-analysis. Tech Coloproctol 2020; 24:787-802. doi:10.1007/s10151-020-02206-9
Tekeli AE, Eker E, Bartin MK, Oner MO. The efficacy of transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy cases: A retrospective evaluation of 515 patients. J Int Med Res 2020; 48:1-9. doi:10.1177/0300060520944058
Bacal V, Rana U, McIsaac DI, Chen I. Transversus abdo-minis plane block for post hysterectomy pain: A systematic review and meta-analysis. J Minim Invasive Gynecol 2019; 26:40-52. doi:10.1016/j.jmig.2018.04.020.
Stamenkovic DM, Bezmarevic M, Bojic S, Unic-Stojanovic D, Stojkovic D, Slavkovic DZ, et al. Updates on wound infiltration use for postoperative pain management: A narrative review. J Clin Med 2021; 10:4659. doi:10.3390/jcm10204659
Talib MT, Sikander RI, Ahsan MF. Ultrasound guided transversus abdominis plane (TAP) block is better than local wound infiltration for postoperative pain management in inguinal hernia repair. Anaesth Crit Care Pain Med 2019; 19:457-62.
Hain E, Maggiori L, Prost A la Denise J, Panis Y. Transve-rsus abdominis plane (TAP) block in laparoscopic colorectal surgery improves postoperative pain management: A meta-analysis. Colorectal Dis 2018; 20: 279-87. doi:10.1111/codi.14037
Johns N, Neill S, Ventham NT, Barron F, Brady RR, Daniel T. Clinical effectiveness of transversus abdominis plane (TAP) block in abdominal surgery: A systematic review and meta-analysis. Colorectal Dis 2012; 14:635-42. doi:10.1111/j.1463-1318.2012.03104
Shahzadi I, Idrees M, Sultana M, Nawaz A, Butt S, Yaq-oob S. Efficacy of transverses abdomens plane (tap) block for post-operative pain in patients undergoing total abdominal hysterectomy. Neuro Quantology 2022; 20:686-94. doi:10.14704/NQ.2022.20.16.NQ88070
Mishra N, Bhagat M, Haque E. The efficacy of transverse abdominis plane block for postoperative analgesia in laparoscopic hysterectomy: A randomized prospective study. Cureus 2023; 15:e34666. doi:10.7759/cureus.34666
Abdallah FW, Chan VW, Brull R. Transversus abdominis plane block: A systematic review. Reg Anesth Pain Med 2012; 37:193-209. doi:10.1097/AAP.0b013e3182429531
Petersen PL, Mathiesen O, Torup H, Dahl JB. The transversus abdominis plane block: A valuable option for postoperative analgesia? A topical review. Acta Anaesthesiol Scand 2010; 54:529-35. doi:10.1111/j.1399-6576.2010.02215.x
Wheeler M, Oderda GM, Ashburn MA, Lipman AG. Adverse events associated with postoperative opioid analgesia: A systematic review. J Pain 2002; 3:159-80. doi:10.1054/jpai.2002.12365
McDonnell JG, 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. doi:10.1213/01.ane.0000250223.49963.0f
Bhattacharjee S, Ray M, Ghose T, Maitra S, Layek A. Analgesic efficacy of transversus abdominis plane block in providing effective perioperative analgesia in patients undergoing total abdominal hysterectomy: A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2014; 30:391-6. doi:10.4103/0970-9185.137274
Ammianickal PL, Thangaswamy CR, Balachander H, Subbaiah M, Kumar NC. Comparing epidural and wound infiltration analgesia for total abdominal hysterectomy: A randomised controlled study. Indian J Anaesth 2018; 62:759-64. doi:10.4103/ija.IJA_124_18
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Muhammad Arif
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Articles published in the Journal of Dow University of Health Sciences are distributed under the terms of the Creative Commons Attribution Non-Commercial License https://creativecommons.org/ licenses/by-nc/4.0/. This license permits use, distribution and reproduction in any medium; provided the original work is properly cited and initial publication in this journal. 
