Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block versus Epidural Block for Postoperative Analgesia Following Lower Abdominal Cancer Surgeries- A Randomised Clinical Study

Abstract

Introduction: Effective post-operative analgesia improves patient’s outcome and satisfaction. Many methods are available to provide best analgesia after major abdominal surgery. Epidural anaesthesia is “gold standard” but it is associated with its own drawbacks. Transversus Abdominis Plane (TAP) block is a comparable technique to epidural to provide reliable analgesia in lower abdominal surgeries. Aim: To compare the efficacy of Ultrasonography (USG) guided TAP block and the epidural block for the post-operative pain management in lower abdominal cancer surgery. Materials and Methods: This randomised clinical double-blinded study, conducted in 60 female patients undergoing lower abdominal cancer surgery under General Anaesthesia (GA) from July 2022 to September 2022. Patients were randomised to Group-E and Group-T. Group-E (Epidural) received injection (inj.) 0.2% Ropivacaine (10 ml) plus inj. Morphine 2 mg via epidural. Group-T (TAP) received inj. 0.2% Ropivacaine (20 ml) plus inj. Morphine 2 mg on each side via USG guided TAP block postoperatively. The Visual Analog Scale (VAS) Score, first rescue analgesia, total analgesic consumption and any side-effects in 24 hours were recorded. The Statistical Package for Social Sciences(SPSS) version 22.0 International Business Management (IBM) Corporation (NY) was used for statistical analysis. Unpaired t test, Chi-square test and Fisher’s-exact test and one-way Analysis of Variance (ANOVA) test were used as and when appropriate. Results: Data of total 60 female patients , 30 patients in each group(Group E mean age: 47.33±9.614 years and Group T mean age: 47.77±12.370 years) was collected and analysed. Both the groups were comparable with respect to age, height, weight, American Society of Anaesthesiologists (ASA) grade, mean duration of surgery and duration of anaesthesia (p>0.05). More patients in group-E had moderate pain at rest and coughing (VAS-4 to 6) at six hours and 12 hours which is statistically significant (p<0.05). None of the patient in both groups had severe pain. Time for need of first rescue analgesic was lower in Group-E (399.6±25.32 min) and in Group-T it was higher (462.6±26.94 min) which is also statistically highly significant (p<0.001). Conclusion: TAP has advantage over epidural in terms of effective postoperative analgesia, time of need and quantity of postoperative analgesics.

Keywords

• analgesic consumption
• major abdominal surgery
• visual analog scale