The Transversus Abdominis Plane Block Provides Effective Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy

TLDR

Patients undergoing total abdominal hysterectomy experience significant postoperative pain, and the transversus abdominis plane (TAP) block is a recently described technique for anterior abdominal wall analgesia. This randomized, double‑blind, controlled trial evaluated the analgesic efficacy of a TAP block with ropivacaine versus placebo in 50 women undergoing elective total abdominal hysterectomy. All participants received general anesthesia and, before incision, a bilateral TAP block was administered with 1.5 mg/kg ropivacaine (max 150 mg) or saline, with postoperative pain assessed by a blinded investigator at multiple time points up to 48 h. The ropivacaine TAP block significantly lowered visual analog pain scores, reduced total morphine consumption (55 ± 17 mg vs 27 ± 20 mg, P < 0.001), decreased sedation incidence, had no complications, and provided superior analgesia for 48 h compared to placebo.

Abstract

Patients undergoing total abdominal hysterectomy suffer significant postoperative pain. The transversus abdominis plane (TAP) block is a recently described approach to providing analgesia to the anterior abdominal wall. We evaluated the analgesic efficacy of the TAP block in patients undergoing total abdominal hysterectomy via a transverse lower abdominal wall incision, in a randomized, controlled, double-blind clinical trial.Fifty females undergoing elective total abdominal hysterectomy were randomized to undergo TAP block with ropivacaine (n = 24) versus placebo (n = 26) in addition to standard postoperative analgesia comprising patient-controlled IV morphine analgesia and regular diclofenac and acetaminophen. All patients received a general anesthetic and, before surgical incision, a bilateral TAP block was performed using 1.5 mg/kg ropivacaine (to a maximal dose of 150 mg) or saline on each side. Each patient was assessed postoperatively by a blinded investigator in the postanesthesia care unit and at 2, 4, 6, 12, 24, 36, 48 h postoperatively.The TAP block with ropivacaine reduced postoperative visual analog scale pain scores compared to placebo block. Mean (+/-SD) total morphine requirements in the first 48 postoperative hours were also reduced (55 +/- 17 mg vs 27 +/- 20 mg, P < 0.001). The incidence of sedation was reduced in patients undergoing TAP blockade. There were no complications attributable to the TAP block.The TAP block, as a component of a multimodal analgesic regimen, provided superior analgesia when compared to placebo block up to 48 postoperative hours after elective total abdominal hysterectomy.