Efficacy of Transversus Abdominis Plane Block versus Epidural Analgesia in Pain Management Following Lower Abdominal Surgery
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- Category: Vol. 85, September 2017
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Efficacy of Transversus Abdominis Plane Block versus Epidural Analgesia in Pain Management Following Lower Abdominal Surgery, TAMER M. KHEIR
Abstract
Background and Objectives: Transversus Abdominis Plane (TAP) block is a new, rapidly expanding technique. And this study was designed to evaluate the efficacy of transversus abdominis plane block in comparison to epidural analgesia in pain management following lower abdominal surgery.
Methods: This present work conducted on 60 patient, with their ages ranging between 20 to 75 years. These patients were admitted at Kasr El-Aini Hospital from February 2013 to March 2014, this patients were allocated to either Group I (TAP) (30 cases) or Group II (epidural block) (30 cases) using a randomized central computer; generated sequence held by an investigator not involved with the clinical manage-ment or data collection.
Results: The primary outcome was the proportion of subjects who used more than 200μg/kg of morphine in the first 24h from arrival in the recovery ward. Secondary outcomes included: Morphine consumption from 0 to 8 and >8 to 24h after operation; pain measured by 0-10 self-assessment Visual Analogue Score (VAS) in the recovery ward and at 2, 6, 10, 14, 18 and 24h after operation, post-Operative Nausea and Vomiting (PONV) measured by the total number of vomits during the first 24h, the main result in this study TAP block provides highly effective post-operative analgesia in the first 24 hours, especially in neurofascial plane in the muscles and the skin but not more the visceral pain, the TAP block reduced mean IV morphine requirements by more than 70%, this reduction in opioid requirement resulted in fewer opioid-mediated side effects. In the present study, there is no signif-icant difference between the studied groups as regard ASA classification, gender distribution and age. In addition, there was no significant difference between groups as regard time at recovery room, need for paracetamol in the first 8 hours after surgical intervention, Post-Operative Nausea and Vom-iting (PONV) and duration of hospital stay. On the other hand, there was significant decrease of total morphine in first 8 hours in Group I in comparison to Group II; and there was significant increase of time when first morphine or first paracetamol needed in Group I (TAP) when compared to Group II. Finally, there was significant decrease of cases needed morphine more than 200μg in the first 24 hours in TAP group when compared to Group II.