Korean J Pain.  2013 Oct;26(4):374-378. 10.3344/kjp.2013.26.4.374.

The Effect of Ultrasound-guided TAPB on Pain Management after Total Abdominal Hysterectomy

• Gharaei H
• Imani F
• Almasi F
• Solimani M

• KMID: 2074046
• DOI: http://doi.org/10.3344/kjp.2013.26.4.374

Abstract

BACKGROUND
Incisional pain is particularly troublesome after hysterectomy. A method called transversus abdominis plane block (TAPB) has shown promise in managing postoperative pain. In this study, we evaluated the analgesic efficacy of ultrasound-guided TAPB after hysterectomy at different time points and at each time point separately for 48 hours.
METHODS
Forty-two patients (ASA I, II) who were electively chosen to undergo total abdominal hysterectomy were divided into 2 groups, control (group C) and intervention (group I). Twenty-one patients underwent TAPB (group I) and 21 patients received only the standard treatment with a fentanyl pump (group C). Both groups received standard general anesthesia. For patients in group I, following the surgery and before emergence from anesthesia, 0.5 mg/kg of ropivacaine 0.2% (about 20 cc) was injected bilaterally between the internal oblique and transverse abdominis muscles using sonography. Pain scores using the Visual Analogue Scale (VAS) and drug consumption were measured at 2, 6, 12, 24, and 48 hours after TAPB.
RESULTS
There were no significant differences in demographics between the two groups. VAS scores appeared to be lower in group I, although there was no interaction with time when we compared mean VAS measurements at different time points between group I and group C (P > 0.05). The amount of fentanyl flow was consistently higher in group C, but when we compared the two groups at each time point separately, the observed difference was not statistically significant (P < 0.053). The incidence of vomiting was 10% in group I and 28% in group C. There were no complaints of itching, and sedation score was 0 to 3. There were no complications.
CONCLUSIONS
This study showed that TAPB did not result in a statistically significant decrease in VAS scores at different time points. TAPB did lead to decreased fentanyl flow, but when we compared the two groups at each time point separately, the observed difference was not statistically significant.

Keyword

fentanyl; hysterectomy; transversus abdominis plane block

MeSH Terms

Amides
Anesthesia
Anesthesia, General
Benzamidines
Control Groups
Demography
Fentanyl
Humans
Hysterectomy
Incidence
Muscles
Pain Management
Pain, Postoperative
Pruritus
Vomiting
Amides
Benzamidines
Fentanyl

Figure

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  Fig. 1 Needle pass through muscle layers. Needle tip between internal oblique and transverse abdominis muscles.

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  Fig. 2 Comparison of VAS scores over time following the TAH.

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  Fig. 3 Comparing mean of flow for fentanyl.

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