Transversus Abdominis Plane Block Versus Local Wound Infiltration for Postoperative Pain Management in Patient Undergoing Total Abdominal Hysterectomy

Abstract

Objective: To compare the outcomes of transversus abdominis plane (TAP) block versus local wound infiltration (LAI) for postoperative analgesia in patients undergoing total abdominal hysterectomy (TAH). Methods: This randomized controlled trial was conducted at Dr. Ziauddin Hospital & Medical College, Karachi, Pakistan from December 2023 to May 2024. Female patients aged 18 to 50 years, and scheduled for TAH under general anesthesia were included. Patients were randomly allocated to the TAP group or the LAI group using sealed opaque envelopes. The primary outcome was pain score at different time intervals postoperatively. Pain score measured using the Visual Analogue Scale. Secondary outcomes included total analgesia consumption within 24 hours. Results: Of total 100 patients, the median (IQR) age was 50.0 (47.2-55.0) years. At 8 hours postoperatively, the median pain score was significantly lower in the TAP group 0.0 (0.0-1.0) compared to the LAI group 1.0 (0.0-2.0) (p-value <0.001). Similarly, at 12 hours, the TAP group reported a median pain score of 2.0 (1.0-2.0), significantly lower than the LAI group 3.0 (2.0-4.0) (p-value <0.001). At 24 hours, the median pain score remained significantly lower in the TAP group 50.0 (50.0-70.0) compared to the LAI group 130.0 (120.0-140.0) (p-value <0.001). Total analgesia consumption was also significantly lower in TAP group as compared to LAI group i.e., 50.0 (50.0-70.0) vs. 130.0 (120.0-140.0) (p-value <0.001). Conclusion: The TAP block provided superior postoperative pain control compared to LAI in patients undergoing TAH, evidenced by lower pain scores and reduced analgesia consumption. Keywords: Analgesia, Hysterectomy, Postoperative Pain, Visual Analogue Scale