COMPARATIVE STUDY OF ULTRASOUND GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK USING BUPIVACAINE WITH AND WITHOUT HYALURONIDASE IN LAPAROSCOPIC BARIATRIC SURGERY

Abstract

Background: Transversus abdominis plane (TAP) block is atechnique of regional anesthesia, which reduces the pain derived from abdominal wall incisions, decreases general anesthesia requirements, and increases hemodynamic stability. Hyaluronidase is an enzyme considered as the “spreading factor”, facilitating the spread of local anesthetic solutions. It has been shown to produce reliable blockade with better spread and therefore better quality of block when used with local anesthetics.Aim of the work: The aim of this study is to compare the efficacy of Injection of Bupivacaine 0.25% and Injection of Bupivacaine 0.25% with Hyaluronidase 1500 Uin ultrasound guided transversus abdominis plane block.Patients and methods: This double blinded randomized controlled clinical trial study was conducted in the Department of anesthesia, Faculty of Medicine, Ain Shams University and general hospitals during the period from 1st January 2018 to 31stDecember 2018 after being approved by the department ethical Committee. The study population included 60 bariatric patients which were randomly divided into 2 groups (30 patients in each group);Group A: TAP block with Bupivacaine 0.25% 19 ml+1 ml normal saline (loading dose) followed by continuous infusion of Bupivacaine 0.25% at a rate of 4ml/hr.; i.e., 96 ml/24hrs.Group B: TAP block with Bupivacaine 0.25% 19 ml+ Hyaluronidase 1500 U 1ml (loading dose) followed by continuous infusion of Bupivacaine 0.25%+ Hyaluronidase 50 U at a rate of 4ml/hr.; i.e., 96 ml/24hrs.Results: the group of TAP block with Bupivacaine and Hyaluronidase (Group B) had statistically lower NRS 2nd, 4th, 6th, 8th,16th, 22ndand 24th postsurgical day (p=0.28, 0.42,0.018, 0.003, 0.003, 0.004 and 0.041 respectively). Also Group B had statistically lower mean of opioid consumption in 2nd, 4th, 6th, 8th,16th, 22th and 24th postsurgical day with overall lower mean of opioid consumption among group B (p=0.002).Regarding vital data among both groups was non-significant (p≥ 0.2).Conclusion: Our findings support the use of ultrasound guided TAP block using liposomal bupivacaine with hyaluronidase as part of multimodal analgesia for bariatric surgery based on decreased postoperative opioid requirements.