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Comparison of preoperative and postoperative approaches to ultrasoundguided transversus abdominis plane block for postoperative analgesia in total abdominal hysterectomy

Background: Transversus Abdominis Plane (TAP) block produces more effective postoperative analgesia and significantly reduces consumption of postoperative opioids after various abdominal surgeries. It can be performed either preoperatively or postoperatively. Furthermore studies investigating the ideal period for TAP block administration are few. The objective of our study was to investigate, which period is more effective for administration of TAP block on postoperative analgesia in patients undergoing total abdominal hysterectomy.

Methods: This prospective randomized controlled double-blind study was conducted with 60 patients between the ages of 18-65 and ASA class I-II who were scheduled to undergo total abdominal hysterectomy. Patients who received a TAP block with ultrasound guidance prior to the surgical procedure were referred to as Group 1, the TAP block procedure after surgery made up Group 2. The rest and movement period Visual Analog Score (VAS), sedation score, nausea, vomiting and the need for additional analgesics were recorded at 2, 4, 6, 12 and 24 hours postoperatively.

Results: When Group 1 was compared with Group 2, the rest period pain scores were significantly lower in Group 2 at 2 and 4 hours (p<0.05). In Group 2, the 24-hour morphine consumption was significantly lower than that of Group 1 (p<0.05).

Conclusion: Post-operative administration of an US guided TAP block in total hysterectomy patients significantly decreased pain scores in early periods and also reduced 24 hour morphine consumption when compared with preoperative administration of the block.

Author(s): Dirican B, Erdogan M, Ucar M, Uzgul U, Gulhas N, Kayhan G, Durmus M