Comparison between ultrasound guided Transversus abdominis plane block and local anesthetic instillation in patients undergoing laparoscopic hysterectomy

Abstract

Background: Post-laparoscopy analgesia is still a challenge. Many studies have been carried out to find the effect of different analgesic techniques in patients undergoing laparoscopic hysterectomy including ultrasonic guided TAP block and instillation of intraperitoneal local anesthetic.Aim: The aim of this study is to assess degree of pain control, duration of action, duration of postoperative analgesia, the effect on postoperative analgesic requirements in patients undergoing laparscopic hysterectomy and compare between Transversus abdominis plane block and intraperitoneal local anesthetics instillation.Materials and Methods: This study enrolled 50 cases for laparoscopic hysterectomy. They were divided randomly into two groups : TAP group (n=25) patients of this group received TAP block performed by ultrasound guidance and IPLA group (n=25) patients of this group received intraperitoneal local anesthetic (bupivacaine) instillation. After surgery, visual analogue score (VAS) was recorded at 1, 2,4,6,12,18 and 24 hours. Requirement of rescue analgesia when VAS score ≥ 4, total dose of morphine received in 24 h were noted in both groups postoperatively.Results: The overall VAS during the first postoperative 24 hours was significantly lower in TAP group (P = 0.048, 0.049, and 0.003 at 6, 12, 18 and 24 hours after surgery) and total analgesic consumption (morphine in mg) was lower (8.36 ± 1.98 mg) in TAP group (8.2 mg) compared to IPLA (12.24 ± 1.33 mg).Conclusion: TAP block provide better postoperative pain control and reduce postoperative opioid requirement in comparison with intraperitoneal local anesthetic instillation in patients undergoing laparscopic hysterectomy.