Clinical evaluation of ultrasound guided transversus abdominis plane block versus subcutaneous infiltration of bupivacaine 0.125% for post-operative analgesia in patients undergoing lower abdominal surgeries
European Journal of Molecular & Clinical Medicine,
2023, Volume 10, Issue 3, Pages 1402-1415
AbstractPostoperative analgesia is an important part of the anaesthetic care. For abdominal surgery, both subcutaneous infiltration and TAP block target on relieving somatic pain. Subcutaneous anaesthetic wound infiltration is easy to perform with low risk. As the advancement of ultrasound technology, performing the TAP block also becomes easier, safer and more accurate. This study is to compare the postoperative pain score, opioid consumption, side effects, and hemodynamic changes between these two analgesic methods in patients undergoing lower abdominal surgery. To compare bilateral ultrasound guided transversus abdominis plane (TAP) block with subcutaneous infiltration of local anaesthetic drug for analgesia after lower abdominal surgeries under general anesthesia.
Study Design: -This study was an Observational hospital based study.
Materials and methods- This prospective observational study, conducted at Gandhi Medical College and associated hospitals, bhopal, After obtaining Institute Ethics Committee approval and written informed consent, 60 participants were included in the study who were undergoing lower abdominal surgeries, 30 participants received 20 ml 0.125 bupivacaine (P) as bilateral ultrasound guided TAP block and 30 participants received 20 ml, 0.125% bupivacaine (P) as subcutaneous wound infiltration at the end of surgery performed under general anesthesia. The primary outcomes were pain scores at 1,2,4,6, 8,12 and 24 hours postoperatively and cumulative tramadol consumption over 24 hours. The secondary outcomes were time to first rescue analgesic, dose of rescue analgesic use and opioids-related side-effects.
Statistical Analysis: The data entry was done in the Microsoft EXCEL spreadsheet and the final analysis was done with the use of Statistical Package for Social Sciences (SPSS) software. For statistical significance, p value of less than 0.05 was considered statistically significant.
Results: The mean time to first analgesia request in minutes were longer in TAP-block with 6.68±2.2 hours compared to mean time of 4.2±1.5 hours in the subcutaneous infiltration group. There were also statistical significant difference with regard to mean Tramadol consumption within 24 h between the two group with P-value<0.001. The mean post operative pain score in PACU at different intervals were significantly lower in TAP block group.
Conclusion: The first analgesia request was significantly longer in addition to less total analgesia consumption in the TAP-block group when compared to subcutaneous infiltration group. Furthermore the TAP-block showed extended pain relief with lower pain VNRS but for immediate and early postoperative pain relief subcutaneous infiltration group recorded lower pain VNRS score than the TAP-block group
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