Comparing a nerve block given into a plane(transversus abdominis plane) on the anterior abdominal wall using ultrasound before putting surgical incision and after putting surgical incision

Completed

Conditions: Those patients posted for total abdominal hysterectomy belonging to ASA 1 or 2 in the department of anaesthesiology at Amala Institute Of Medical Sciences,Thrissur,kerala

Registration Number: CTRI/2018/04/013312

Lead Sponsor: Department of Anaesthesiology

Brief Summary: Transversus abdominis plane block is an effective block for post operative pain relief in lower abdominal surgeries like total abdominal hysterectomy and is more effective when performed under ultrasound guidance.It is said that blocks performed before surgical incision is more effective as compared to blocks performed after completion of surgery.Hence present study was undertaken to compare the efficacy of ultrasound guided transversus abdominis plane block performed before surgical incision with that performed after surgery.Here 54 patients coming under inclusion criteria were alternatively allocated to receive either pre-incisional or post-incisional TAp block.Each patients received 20 ml of 0.5% Bupivacaine for block bilaterally under ultrasound.Post operatively they where assessed for pain ,requirement for rescue analgesia with morphine and their opioid dependent side effects like nausea vomiting,sedation score, respiratory depression and other complications of block.A statistically significant decrease in post operative pain was noticed from 2nd post-operative hour onward till 12 hours and thereafter it was comparable between both the groups.The total morphine required in the first 24-hour post-operative period was significantly less in the pre-incisional TAP block group (36mg) compared to the other group (123 mg). Also,the mean time to first request for morphine was significantly longer in patients belonging to the pre-incisional TAP block group (pre incisional group 10.8 hours vs post incisional group 3.64 hours with a p value of 0.002).There was no significant difference in sedation scores post-operatively,except at 4th hour,where it was significantly higher(0.024) in the post-incisional group.Post operative nausea and vomiting was also significanlty higher and the dose of anti-emetic used was also more in the post-incisional TAP block group.

Detailed Description: Not available

Recruitment & Eligibility

Status: Completed

Sex: Female

Target Recruitment: 54

Inclusion Criteria

a)Patients scheduled for total abdominal hysterectomy with or without oophorectomy using Pfannensteil incision.
b)Patients belonging to ASA I and II.
c)Age 30-60 years.

Exclusion Criteria

a)Patient refusal for the procedure b)History of relevant drug allergy, coagulopathy or opioid dependence.
c)TAP block using drugs other than bupivacaine.
d)Patients in whom spinal anaesthesia is contra indicated.
e)Failed spinal anaesthesia.
f)Patients with BMI â‰¥ 30.

Study & Design

Study Type: Observational

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
To compare between the effects of pre versus post incisional transversus abdominis plane block on acute post-abdominal hysterectomy pain. The primary outcome measures included VAS scores, post-operative opioid consumption in the first 24 hours and any complications of TAP block.	First 24 hours following surgery

Secondary Outcome Measures

Name	Time	Method
The secondary outcome measures included PONV, sedation and the need for rescue antiemetics.	First 24 hours following surgery

Trial Locations

Locations (1): Amala Institute Of Medical Sciences.
🇮🇳
Thrissur, KERALA, India
Amala Institute Of Medical Sciences.
🇮🇳Thrissur, KERALA, India
Dr Emy Ambooken
Principal investigator
9809750033
emyambooken@gmail.com