Abstract
Introduction: Management of post-operative Pain is gaining considerable attention with pain being recognized as the fifth vital sign. Post- operative pain management remains unresolved as pain is individualized and varies with surgery. The aim is to evaluate the analgesic efficacy of transverses abdominis plane block by continuous catheter technique and systemic analgesia for post-operative pain in total abdominal hysterectomy. Subjects and Methods: This randomized controlled trial was done in patients undergoing total abdominal hysterectomy via Pfannenstiel incision. Patients were assigned into 2 groups, systemic analgesics group (n=25) and TAP block group (n=25) randomly. Results: Out of 50 patients, 25 patients had systemic analgesics and 25 patients had TAP block. Demographics and surgical procedure times were comparable. Mean VAS pain score with coughing on day 1 and 2 in systemic analgesics group was 3.96 and 2.07 and in TAP block group were
 0.7 and 0.3. Meantime taken to mobilize the patient after the surgery in the systemic analgesics group was 30.7 hours and in TAP block group was 22.4 hour. 18 patients needed rescue medication in the systemic analgesics group, and 9 patients required rescue medication in the TAP block group. In group 16 patients with systemic analgesics had post-operative nausea and vomiting, and 5 patients in group block TAP. Conclusion: Continuous TAP block provides better pain relief, denoted by lower visual analogue scores and better recovery profile enhancing recovery in patients undergoing abdominal hysterectomy.
Highlights
Management of post-operative Pain is gaining considerable attention with pain being recognized as the fifth vital sign
Factors influencing post-operative pain management technique are the site of surgery, familiarity with different methods of analgesia and the availability of resources to monitor in the post-operative period. [1]
Extensive use of opioids is associated with a variety of side effects, such as ventilatory depression, drowsiness and sedation, post-operative nausea and vomiting (PONV), pruritus, urinary retention, ileus and constipation that can delay hospital discharge
Summary
Management of post-operative Pain is gaining considerable attention with pain being recognized as the fifth vital sign. The aim is to evaluate the analgesic efficacy of transverses abdominis plane block by continuous catheter technique and systemic analgesia for post-operative pain in total abdominal hysterectomy. Meantime taken to mobilize the patient after the surgery in the systemic analgesics group was 30.7 hours and in TAP block group was 22.4 hour. In group 16 patients with systemic analgesics had post-operative nausea and vomiting, and 5 patients in group block TAP. Conclusion: Continuous TAP block provides better pain relief, denoted by lower visual analogue scores and better recovery profile enhancing recovery in patients undergoing abdominal hysterectomy. Effective pain relief provides a smoother post-operative course with earlier discharge from hospital, but it may reduce the onset of chronic pain syndromes. Systemic opoids and an epidural infusion in high risk cases have been the modalities of post operative pain management in hysterectomies. Extensive use of opioids is associated with a variety of side effects, such as ventilatory depression, drowsiness and sedation, post-operative nausea and vomiting (PONV), pruritus, urinary retention, ileus and constipation that can delay hospital discharge. [2] Intra- and post-operative usage of high doses of bolus or constant infusions of strong opioid analgesics can significantly enhance post-operative pain as a result of their rapid withdrawal and acute tolerance build. [3]
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