Transversus abdominis plane block with ropivacaine provides effective analgesiain patients undergoing total abdominal hysterectomy

Abstract

: Transversus abdominis plane (TAP) block provides a novel approach for analgesia in abdominal surgery by blocking the sensory nerve supply of the anterior abdominal wall. We evaluated the analgesic efficacy of TAP block with ropivacaine in patients undergoing total abdominal hysterectomy (TAH). 60 adult patients of ASA Grade 1 and 2 undergoing elective TAH were randomized into two groups in this double blind study. All patients received a standard general anaesthetic and before the surgical incision, a bilateral TAP block using the landmark technique was performed with 15 to 20 mlof 0.375% ropivacaine (maximum dose 3mg/kg) (Group R) or saline (Group C). Assessment of hemodynamic parameters and requirement of vecuronium and opioids was noted intraoperatively. Postoperative assessment of pain was performed at regular intervals using visual analog scale (VAS) and categorical pain score (CPS), and total analgesics administered over 48 hrs were noted.: Intraoperative hemodynamic parameters showed significantly lower mean values in the ropivacaine group till 50 minutes and from 80 to 120 minutes after the surgical incision. (p value<0.05). Duration of TAP block was significantly longer in the ropivacaine group (383 mins vs 221mins, p=0.000). Mean intraoperative requirement of fentanyl and vecuronium (p=0.000), and postoperative requirement of diclofenac at 24 hrs (p=0.004) and 48 hours (p=0.007) was significantly lower in Group R.VAS and CPS scores were significantly lower in the ropivacaine group till 2 hours postoperatively(p=0.000). : TAP block with ropivacaine provides effective intraoperative analgesia and decreases postoperative analgesic requirement till 48hours in patients undergoing total abdominal hysterectomy.