Analgesic effect of ultrasound-guided transversus abdominis plane block after total abdominal hysterectomy: A randomized, double-blind, placebo-controlled trial

• Røjskjær Jesper O.
• Gade Erik
• Kiel Louise B.
• Lind Morten N.
• Pedersen Lars M.
• Kristensen Billy B.
• Rasmussen Yvonne H.
• Foss Nicolai B.

Abstract

Objective. To assess the effect of bilateral ultrasound-guided transversus abdominis plane-block with ropivacaine compared with placebo as part of a multimodal analgesic regimen.

Design. A randomized, double-blind, placebo-con-trolled trial following the CONSORT criteria.

Setting. Hvidovre University Hospital.

Patients. 46 patients scheduled for total abdominal hysterectomy.

Intervention. Patients received either ropivacaine 0,75%, 20 ml (n=24) or 0,9% saline, 20 ml (n=24) in the tranversus abdominis plane on each side.

Main outcome measures. Primary outcome was the 24 hour postoperative morphine consumption. Secondary outcomes were pain scores at rest and during coughing, postoperative nausea and vomiting at 1, 2, 4, 6, 8, and 24 hours, and time to first mobilization.

Results. There was no difference in the mean 24 hour postoperative morphine consumption between the two groups (p=0,733). The ropivacaine group had significantly lower median pain scores at 1 hour (p=0,008) and 2 hours (p=0,027) postoperatively at rest and at 8 hours (p=0,028) during coughing. There was no significant difference in other secondary outcomes.

Conclusion. There was no reduction in 24 hour morphine consumption when using an ultrasound-guided transversus abdominis plane-block in women undergoing total abdominal hysterectomy. As part of a multimodal regimen the transversus abdominis plane-block showed some effect on pain scores at rest only in the early postoperative period.

Keywords:physterectomy, anesthesia and analgesia, postoperative pain, anesthesia regional, randomized controlled trial