Comparison of ultrasound-guided transverse abdominis plane block on intraoperative and postoperative analgesia at different time points in total abdominal hysterectomy

Abstract

Objective To evaluate the influence of ultrasound-guided transverse abdominis plane (us-TAP) block on intraoperative and postoperative analgesia at different time points in total abdominal hysterectomy. Methods 46 patients undergoing total hysterectomy under general anesthesia were selected, randomly divided into two groups, group A and group B, with 23 cases in each group. Group A received bilateral us-TAP block after induction of general anesthesia and before operation; Group B received bilateral us-TAP block after operation and before anesthesia recovery. In both groups, the anesthesia was adjusted according to the bispect ral index (BIS) and hemodynamics. Sufentanil was used for patient-controlled intravenous analgesia (PCIA) after operation. The mean blood pressure (MBP), heart rate (HR) at T0 (pre-anesthesia), T1 (skin incision), T2 (postoperation), T3 (tracheal extubation), T4 [leave the post anesthesia care unit (PACU)] in both two groups were recorded. The dosage of anesthetics during operation and the recovery time after operation were recorded. Visual analogue scores (VAS) at 2 h, 6 h, 12 h and 24 h after operation were observed in the resting and coughing state of the patients in the two groups. The total consumption of analgesics 24 h after surgery and the side effects of nausea and vomiting were recorded. Results MAP and HR in group A were significantly lower than that in group B at T1 (P<0.05), but there was no statistical difference at other time points (P<0.05). The dose of sufentanil used in group A was less than that in group B (P<0.05). The recovery time in group A was shorter than that in group B (P<0.05). At 2 h, 6 h, 12 h and 24 h post operation, there was no significant difference at rest and coughing VAS between the two groups (P<0.05). There was no difference in the consumption of analgesics 24 hours after operation between the two groups (P<0.05). The incidence of postoperative nausea and vomiting in group A was lower than that in group B (P<0.05). Conclusions In open hysterectomy, although the analgesic effect of us-TAP blockade before and after operation is not significantly different, preoperative TAP blockade under ultrasound can effectively reduce the amount of intraoperative general anesthetics and accelerate the recovery of patients, effectively reducing the incidence of postoperative nausea and vomiting. Key words: Nerve block; Abdominal muscles; Ultrasonography; Hysterectomy