Abstract
<p style="margin-bottom: 0in;"><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em><strong>Objective: </strong></em></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">To assess the effectiveness of surgical TAP block in providing post-operative analgesia in women undergoing total abdominal hysterectomy through supra pubic transverse incision under general anaesthesia<br /></span></span><strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em><strong>Design: </strong></em></span></span></strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">A randomized controlled study<br /></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em><strong>Setting: </strong></em></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">Professorial Unit, Colombo South Teaching Hospital, Kalubowila<br /></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><strong><em>Population: </em></strong></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">A total of forty women scheduled to undergo total abdominal hysterectomy for benign conditions<br /></span></span><strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em>Methodology: </em></span></span></strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">Women were randomized and the intervention arm received TAP block. Both arms received standard analgesia. The pain was assessed by visual analogue pain score at specific time intervals.<br /></span></span><strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em>Main outcome measure: </em></span></span></strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">Requirement of pethidine for pain relief for 24 hours and assessment of post-operative pain using a visual analogue scale at specific intervals up to 24 hours<br /></span></span><strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em>Results: </em></span></span></strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">Compared to controls, in women who received TAP block, there was a statistically significant reduction in pain at 30 minutes (pain score 4.5+1.3 vs. 5.4+1.0, p=0.02), at 1h (4.4±1.0 vs. 5.2±0.7, p=0.01), at 2h (4.0±0.9 vs. 4.8±0.7, p=0.01), at 3h (3.6±0.8 vs. 4.3±0.7, p=0.01), at 6hrs (2.8±0.9 vs. 3.0±0.7, p=0.001), and at 12hrs (2.1±1.0 vs. 3.0±0.9, p=0.01). At 24hrs, there was no significant difference in pain reduction. (1.4±0.5 vs. 1.8±0.7, p=0.11). The cumulative morphine requirement was also significantly less in the TAP group at all the time points.<br /></span></span><strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em>Conclusion: </em></span></span></strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">The TAP block provided highly effective postoperative analgesia following total abdominal hysterectomy and the cumulative morphine requirement was also significantly less in the TAP group at all the time points. It should be considered as part of a multimodal approach to anaesthesia and enhanced recovery in patients undergoing abdominal surgery.<br /><br /></span></span>DOI: <a href="http://dx.doi.org/10.4038/sljog.v36i1.6954">http://dx.doi.org/10.4038/sljog.v36i1.6954</a> <em>Sri Lanka Journal of Obstetrics and Gynaecology </em>2014; 36: 5-10
Highlights
Adequate postoperative pain relief modifies the surgical stress response, aids recovery and leads to a better outcome following surgery[1,2]
The pain was assessed by visual analogue pain score at specific time intervals
At 24hrs, there was no significant difference in pain reduction. (1.4±0.5 vs. 1.8±0.7, p=0.11)
Summary
Adequate postoperative pain relief modifies the surgical stress response, aids recovery and leads to a better outcome following surgery[1,2]. Additional adjuncts include catheters placed within the correct plane, which provide a longer-lasting infusion of local anaesthesia[9]. This blind technique is difficult in obese patients and carries potential risk of peritoneal puncture and possible visceral injury[10]. Open ‘surgically placed’ TAP blocks have been described, with local anaesthetic infiltration under direct vision in the TAP through the incision at the time of surgery[13,15]. This has been shown to reduce all the possible complications described above[16]
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