Postoperative analgesic efficacy between transversus abdominis plane block and wound site local anesthesia infiltration in total abdominal hysterectomy under spinal anesthesia - a comparative study

Objectives: This prospective comparative hospital-based study aimed to assess the postoperative analgesic effectiveness of transversus abdominis plane block compared to wound site local anesthesia infiltration in total abdominal hysterectomy under spinal anesthesia.The primary objectives included comparing the time to the first request for rescue analgesia and the total postoperative analgesic requirement over 24 hours.Methods: The study included 60 patients divided into two groups, A and B, with 30 patients in each.Patients aged 18-60 yeras, belonging to ASA status I and II, scheduled for elective total abdominal hysterectomy under spinal anesthesia were enrolled.Both groups received spinal anesthesia with 0.5% bupivacaine heavy.In group A, bilateral transversus abdominis plane (TAP) block using 10 ml 0.25% bupivacaine on each side was administered, while in group B, 20 ml (10 ml on each side) of 0.25% bupivacaine was subcutaneously infiltrated just before skin wound closure.The study recorded the time to first rescue analgesia, total analgesic consumption in 24 hours, postoperative VAS score, and any systemic side effects.Results: Patient demographics and intraoperative parameters showed no significant differences between the two groups.The TAP block in group A significantly prolonged postoperative analgesia (299.1324.35minutes) compared to group B (182.4324.88minutes).The total rescue analgesic (IV tramadol) received in 24 hours postoperatively was significantly lower in group A (123.3343.01mg)compared to group B (233.3371.11mg).VAS scores indicated a substantial difference in postoperative pain between groups A and B from the 2nd hour onwards.Adverse effects were low in both groups, with group A showing fewer side effects (16.67%) than group B (33.33%).Notably, nausea and vomiting were observed in 2 patients in group A and 4 patients in group B, while other complications were not observed in the study population.Conclusion: In conclusion, TAP block demonstrated better postoperative analgesia, reflected in prolonged duration, improved quality (lower VAS score), and reduced total rescue analgesic requirement compared to wound site local anesthesia infiltration.