Postoperative analgesia after major abdominal gynaecological surgery using surgical transversus abdominis plane block

Abstract

Background: Gynecological surgeries are often associated with severe pain requiring a well-planned analgesia regimen to ensure adequate patient‑comfort, satisfaction, early mobilization, and to decrease the hospital/post-anesthesia care unit (PACU) stay. Transversus abdominis plane (TAP) block is the technique to block the sensory nerves of the anterior abdominal wall and the TAP block has been used to control the pain after abdominal surgery in many cases. By incorporating TAP block in post-operative management, it may be possible to decrease narcotic use while also avoiding some of the potential side effects of neuraxial anesthesia such as respiratory depression and risk of spinal hematoma.Methods: In the present study, sixty patients undergoing major gynaecological surgeries were included. The study participants were divided into 2 groups of 30 each. One group received TAP block.Results: Among 60 patients, the mean age of the study participants was found to be 48.53±8.97 years. Only 22% of the study participants had the history of previous surgery. 80 % of the study participants underwent Total Abdominal Hystrectomy (TAH). In the present study, the overall mean hourly VAS score among Group 2 (No TAP block) was found to be lower than Group 1 (TAP block) at all hours. The mean time of rescue analgesia in Group 1 was found to be 12.30±6.87 hours. The mean time of rescue analgesia in Group 2 was found to be 2.8±1.49 hours.Conclusions: Surgical TAP block has been proved to cater significant analgesic effect especially below T10 up to L1 level; hence, it is perfectly suited for use after lower abdominal and gynecological surgeries. Prolonged analgesic effect can be achieved by continuous blockade using catheter for drug delivery, but it is technically more demanding. This study reinforces the recommendation for TAP as a part of multimodal post-operative analgesic regimen.