Efficacy of adding hyaluronidase to bupivacaine in ultrasound guided transversus abdominis plane block for postoperative analgesia after abdominal hysterectomy

Background and aim Transversus abdominis plane (TAP) blockade is a good method for the management of agonizing postoperative pain. As various nerves can be blocked in a sole prick, using hyaluronidase enzyme may progress the spread of the local anesthetic drugs. This work aimed to determine the efficacy of addition of hyaluronidase to bupivacaine in ultrasound (USG)-guided TAP block. Patients and methods A total of 50 female patients planned for noncompulsory total abdominal hysterectomy randomized into two groups: group B 25 patients underwent USG-guided bilateral TAP block with Bupivacaine alone and group BH underwent USG-guided bilateral TAP block with bupivacaine and hyaluronidase. Results USG-guided bilateral TAP blockade by bupivacaine and hyaluronidase was more effective than bupivacaine alone. Bupivacaine and hyaluronidase combination was associated with a longer time to request rescue analgesia 6.36±1.55 versus 3.24±1.05 h, the lesser total dose of nalbuphine consumption in the first 24 h 13.92±2.34 versus 16.8±2.31 mg and lower postoperative visual analog scale score 3 (2–4) versus 5 (3–6). On the other hand, no differences were noted between study groups regarding demographic data, duration of surgery, hemodynamic state (baseline, before induction of anesthesia and at the end of surgery), and complications of the used medications as local anesthetic toxicity and hematoma at the site of injection. Conclusion USG-guided bilateral TAP block using bupivacaine and hyaluronidase had a potent analgesic effect compared with bupivacaine alone.