Abstract
Background
Transversus abdominis plane (TAP) block has been shown to provide pain relief after abdominal procedures. However, TAP block combined with multimodal analgesia technique have not been assessed in a randomized controlled trial. This randomized, controlled, observer-blinded study was designed to evaluate the analgesic efficacy of bilateral ultrasound-guided TAP blocks with or without acetaminophen and non-steroidal anti-inflammatory drug (NSAID) combination.
Methods
Patients undergoing total abdominal hysterectomy were randomized to one of three groups. Group 1 (n = 25) received a TAP block and ketorolac 30 mg, IV at the end of surgery and then ketorolac plus paracetamol 650 mg, orally, every 6 h for 24 h. Group 2 (n = 24) received only TAP block at the end of surgery. Group 3 (n = 25) received ketorolac 30 mg, IV at the end of surgery and then ketorolac plus paracetamol 650 mg, orally, every 6 h for 24 h. All patients received IV-PCA morphine for 24-h, postoperatively. All patients received a standardized general anaesthetic technique and dexamethasone 4 mg and ondansetron 4 mg, IV for antiemetic prophylaxis.
Results
There were no statistically significant differences in pain at rest between the groups. However, the pain on coughing (dynamic pain) in Group 1 was significantly less variable, compared with the other two groups (P = 0.012). Opioid consumption and occurrences of nausea, vomiting, and rescue antiemetic were similar in three the groups.
Conclusions
The combination of TAP block and acetaminophen and NSAID provided less variability in dynamic pain compared with either treatment alone.
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Acknowledgments
The authors would like to thank Joe Howard, NP, and Michelle Craven, MD for their assistance with data collection, Enrique Escobar, MD for assistance with data analysis, and Allison Smith, MD for support with conduct of the study.
Conflict of interest
Girish P. Joshi has received honoraria from Pfizer, Eisai, Baxter, and Cadence Pharmaceuticals.
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United States National Clinical Trials Registry NCT01153503.
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Gasanova, I., Grant, E., Way, M. et al. Ultrasound-guided Transversus abdominal plane block with multimodal analgesia for pain management after total abdominal hysterectomy. Arch Gynecol Obstet 288, 105–111 (2013). https://doi.org/10.1007/s00404-012-2698-3
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DOI: https://doi.org/10.1007/s00404-012-2698-3