Share this article on:

Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Laparoscopic Hysterectomy: A Randomized, Controlled, Observer-Blinded Trial

Ghisi, Daniela MD; Fanelli, Andrea MD; Vianello, Federico MD; Gardini, Marco MD; Mensi, Giulio MD; La Colla, Luca MD; Danelli, Giorgio MD

doi: 10.1213/ANE.0000000000001267
Regional Anesthesia and Acute Pain Medicine: Original Clinical Research Report

BACKGROUND: In this randomized, controlled, observer-blinded study, we evaluated analgesia provided by transversus abdominis plane (TAP) block after elective total laparoscopic hysterectomy in terms of reduced postoperative morphine consumption as the primary end point.

METHODS: Fifty-two patients were randomly divided into 2 groups: patients in group T (TAP, n = 26) received an ultrasound-guided bilateral TAP block with 40 mL of 0.375% levobupivacaine and morphine patient-controlled analgesia, whereas patients in group C (control, n = 26) received morphine patient-controlled analgesia. Secondary outcomes included pain measurements (Numeric Rating Scale from 0 to 10) during the first 24 hours postoperatively, times to postanesthesia care unit discharge, times to surgical ward discharge, incidence of postoperative nausea and vomiting, functional capacity measurements in terms of 2-minute walking test, and first oral solid intake.

RESULTS: Demographic and anthropometric variables were similar in the 2 groups. The total dose of morphine consumed by patients during postanesthesia care unit stay was 6 (0–8) mg in group T vs 8 (5.5–8.5) mg in group C (P = 0.154). Postoperative morphine consumption during the first 24 hours was 10.55 ± 10.24 mg in group C vs 10.73 ± 13.45 mg in group T (P = 0.950). The 95% confidence interval of the difference between means of 24-hour morphine consumption was −7.45 to +7.09. The 2 groups were comparable. There were no significant differences in secondary outcome variables between groups.

CONCLUSIONS: TAP block did not reduce morphine consumption during the first postoperative 24 hours after elective total laparoscopic hysterectomy.

Published ahead of print April 12, 2016

From the *Department of Anesthesia and Perioperative Medicine, Istituti Ospitalieri di Cremona, Cremona, Italy; Department of Gynaecology and Obstetrics, Istituti Ospitalieri di Cremona, Cremona, Italy; and Department of Anesthesia, Intensive Care and Pain Therapy, University Hospital Parma, Parma, Italy.

Published ahead of print April 12, 2016

Daniela Ghisi, MD, is currently affiliated with the Department of Anesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy.

Andrea Fanelli, MD, is currently affiliated with the Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Sant’Orsola, Bologna, Italy.

Federico Vianello, MD, is currently affiliated with the Department of Gynecology and Obstetrics, Azienda Ospedaliera Carlo Poma di Mantova, Mantova, Italy.

Marco Gardini, MD, is currently affiliated with the Department of Anesthesia and Perioperative Medicine, Istituti Ospitalieri Cremona, Cremona, Italy.

Accepted for publication January 10, 2016.

Funding: Self-financed by the Department of Anaesthesia and Perioperative Medicine, Istituti Ospitalieri, Cremona, CR, Italy.

The authors declare no conflicts of interest.

This report was previously presented, in part, at the XIX European Society of Regional Anesthesia Italian Meeting.

Reprints will not be available from the authors.

Address correspondence to Daniela Ghisi, MD, Department of Anesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli via GC Pupilli, 1 40136 Bologna, BO, Italy. Address e-mail to ghisidan@hotmail.com.

© 2016 International Anesthesia Research Society