Transversus Abdominis Plane Block : A Complementary Technique for Post Operative Analgesia in Lower Abdominal Gynecological Cancer Surgeries

Abstract

BACKGROUND: Gynecological cancer surgeries differ from non-cancer surgeries as the former involves extensive dissection, and tissue handling, which contributes to increased nociception perioperatively. Radical hysterectomy with pelvic lymph node dissection is one of the most commonly performed surgeries in gynecological oncological set up. Transversus abdominis plane (TAP) block is one of the new promising regional anesthesia technique complementing multi modal analgesic regimen. This is a prospective randomized controlled trial. We evaluated the role of the TAP block in Radical hysterectomy with pelvic lymph node dissection for perioperative analgesia and reducing the requirement of opioid consumption. METHODS: 100 patients of ASA grade 1 and 2 undergoing radical hysterectomy and pelvic lymph node dissection with below umbilical incision were randomized as block group to undergo TAP block with bupivacaine 0.25% 20ml on each side (n=50), versus non-block group (n=50). All patients received general anesthethesia. Block was performed before surgical incision bilaterally by using blind double pop technique in patients who were randomized to the block group. Intra operative analgesic regimen was with inj fentanyl 1.5 mic/k.g, repeated with 0.5mic/k.g depending on the requirement as assessed by the anaesthesiologist based on haemodynamic parameters and post operatively by pain scores on numeric visual analogue scale with inj. paracetamol 1gm followed by tramadol 2mg/kg and fentany 0.5mic/kg. Each patient was assessed post operatively at 0, 2, 4, 6, 8,12,16,20,24 hours for pain, nausea, vomiting and sedation. The data recorded. Descriptive and inferential statistical analysis has been carried out using student t test, chi square/ fisher exact test in the present study. RESULTS: We studied 100 patients, 50 patients in block group and 50 patients in non-block group. The block group had significantly less pain scores compared to non-block group, p value being < 0.001. Total requirement of opioids in 24 hours was reduced in the block group, p<0.001. Time to first request for analgesia was delayed in the block group where only 22% patients needed analgesic at 0 hours compared to 72% in non-block group. Incidence of nausea and vomiting was reduced after 4 hours in block group. The non-block group patients were less sedated at 0 and 2 hours probably due to pain. There were no complications attributable to the block. CONCLUSION: TAP block as a complementary technique to the multimodal analgesia protocol, provided improved quality of analgesia with reduced opioid requirement and their side effects in block group compared to non-block group for radical hysterectomy and pelvic lymph node dissection with incision below the umbilicus KEYWORDS: Post-operative pain, regional anaesthesia technique. INTRODUCTION:Gynecological cancer surgeries differ from non-cancer surgeries as the former involves extensive dissection, and tissue handling, hence contributes to increased nociception perioperatively. Radical hysterectomy with...