Comparison Between The Effectiveness of Lateral and Posterior Transversus Abdominis Plane Block by Using Bupivacaine After Total Abdominal Hysterectomy.

KYAMC Journal Pub Date : 2022-09-05 DOI:10.3329/kyamcj.v13i2.61333

Miraj Hossain, Major Muhammad Nazrul Islam, Zannatul Ferdous Happy, Moinul Hossain, A. Akhtaruzzaman

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Abstract

Background: Transversus Abdominis Plane (TAP) block is a regional anaesthetic technique used for postoperative pain management following abdominal surgery. Local anesthetics like bupivacaine can be used in this block and it can be performed in various approaches. Among them ultrasound-guided lateral and posterior approaches are popular. Objective: Aim of this study is to compare the effectiveness of lateral and posterior approaches of ultrasound-guided TAP block using bupivacaine in the management of post-operative pain after total abdominal hysterectomy under subarachnoid anesthesia. Materials and Methods: This randomized clinical trial was carried out in the Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka. Total 90 patients were scheduled for elective total abdominal hysterectomy and assigned into two equal groups, group A and group B received ultrasound guided TAP block in lateral approach and in posterior approach respectively. Then patients were observed for pain intensity at rest and during deep breath by visual analog scale (VAS), after 1 hour, 2 hours, 4 hours, 6 hours, 12 hours and 24 hours of TAP block. The time of first analgesic demand was noted. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: The mean pain intensity at rest and during deep breath was statistically significant (p<0.05) at 4, 6, 12 and 24 hours after TAP between two groups. The mean duration of first analgesic demand was 5.04±0.54 hours in group A and 6.59±0.69 hours in group B was statistically significant (p<0.05) between two groups. Conclusion: TAP block in posterior approach provided considerably effective postoperative analgesia in first 24 hours than lateral approach after total abdominal hysterectomy. KYAMC Journal Vol. 13, No. 02, July 2022: 66-71

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布比卡因用于腹式全子宫切除术后腹横面阻滞的效果比较。

背景:腹横面阻滞(TAP)是一种用于腹部手术后疼痛管理的区域麻醉技术。像布比卡因这样的局部麻醉剂可以在这个街区使用，并且可以通过各种方式进行。其中超声引导下的外侧入路和后路是常用的入路。目的:比较超声引导下布比卡因侧路和后路TAP阻滞治疗蛛网膜下腔麻醉下全腹子宫切除术后疼痛的效果。材料与方法:本随机临床试验在达卡班班杜谢赫穆吉布医科大学(BSMMU)麻醉、镇痛和重症监护医学系进行。选择择期腹式全子宫切除术90例患者，随机分为两组，A组和B组分别行超声引导下外侧入路和后入路TAP阻滞。通过视觉模拟评分法(VAS)观察患者在TAP阻滞1小时、2小时、4小时、6小时、12小时和24小时后休息时和深呼吸时的疼痛强度。记录首次使用镇痛药的时间。采用SPSS-22 (Statistical Packages for Social Sciences)软件进行统计分析。结果:两组在TAP后4、6、12、24 h静息和深呼吸时的平均疼痛强度比较，差异均有统计学意义(p<0.05)。A组和B组患者首次镇痛需求平均持续时间分别为5.04±0.54 h和6.59±0.69 h，两组间差异有统计学意义(p<0.05)。结论:TAP阻滞在全腹子宫切除术后24小时内的镇痛效果明显优于外侧入路。KYAMC杂志第13卷，第02期，2022年7月:66-71

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KYAMC Journal

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