Abstract PR301

Abstract

Background & Objectives: The multimodal analgesic strategy has become the main option in postoperative pain management. Multimodal techniques for post-appendicectomy pain include the administration of systemic opioids alone or in combination with local anaesthetic for regional anaesthesia and blocks of abdominal wall nerves; such as ilioinguinal blockade and Transversus Abdominis Plane (TAP) block. This study evaluated the place of ultrasound-guided TAP block in the management of post-appendicectomy pain. Materials & Methods: Following approval from the Institutional Research and Ethics Committee, seventy two patients scheduled for appendicectomy were randomized into two groups to receive 20ml of 0.25% plain bupivacaine or 20ml of sterile saline for ultrasound-guided unilateral TAP block at the end of appendicectomy. Spinal anaesthesia for appendicectomy was achieved using a combination of 3ml (15mg) of 0.5% hyperbaric bupivacaine and 10mg of preservative free pethidine (0.2ml). The proportion of patients with VAS scores of ≤ 3, at the 4th hour postoperatively was the primary outcome. Other secondary outcomes included the time to request for first analgesia, occurrence of nausea, vomiting, pruritus, and maternal satisfaction with the TAP block. Continuous data were compared using t-test while categorical data were compared using Fisher’s exact test. P value< 0.05 was considered significant. Results: The demographic characteristics were similar in both groups. There was significant difference in the proportion of patients who required analgesic at the second hour: none in the TAP-LA while 12 patients (33.3%) in TAP-S had pain (P < 0.0002). At the fourth hour, no patients in group TAP-LA requested for analgesic as against 36(100%) in group 2 (p < 0.0001). At the sixth hour, 15 (41.6%) patients requested for analgesic in TAP-LA (P < 0.0001) while all group TAP-S had earlier requested for analgesia prior to the sixth hour. The time to first analgesia request was 477.14±216.33 minutes in group TAP-LA and 160.17 ±37.42 minutes in group TAP-S (P < 0.0001). The mean paracetamol consumption in 24 hours was significantly higher in group TAP-S (2350 ±168.18mg) compared to 1250 ±363.147mg in group TAP-LA (P < 0.0001), while the mean tramadol consumption in 24 hours postoperatively was significantly higher in group TAP-S (363.89±48.71mg) compared to 216.67±65.47mg in group TAP-LA (P < 0.0001). Conclusion: Ultrasound guided unilateral TAP blocks with bupivacaine resulted in decreased VAS scores up to the postoperative 6th hour, prolonged time to first analgesic request and decreased analgesics consumption compared to saline. TAP block should be added to the postoperative analgesic regime following appendicectomy in a multimodal analgesia strategy. Disclosure of Interest: None declared