Comparison of lumbar epidural analgesia, transversus abdominis plane block, and surgical wound infiltration for postoperative pain relief in patients with major gynecologic surgery

Purpose: This study compared lumbar epidural analgesia (LEA), transversus abdominis plane (TAP) block, and surgical wound infiltration (SWI) for postoperative analgesia, patient satisfaction, and side effects in major gynecologic surgery. Materials and Methods: Eighty-one patients were randomized into three groups: lumbar epidural block (Group LEA), TAP block (Group TAP), and SWI (Group SWI). Demographic data, surgical characteristics, hemodynamic variables, total morphine consumption, time to first rescue analgesia, pain scores, and side effects were recorded at 1, 2, 6, 12, 24, 36, and 48 hours, along with patient satisfaction scores at 24 and 48 hours postoperatively. Results: Heart rate was significantly lower in Group LEA than in Group SWI and Group TAP. Postoperative 48-h total morphine consumption was significantly lower in Group LEA (9.63 ± 5.7 mg) than in Group TAP (15.30 ± 4.0 mg) and Group SWI (16.93 ± 5.9 mg). Postoperative pain scores were significantly lower in Group LEA than in the other groups. Time to first rescue analgesia was significantly longer in Group LEA (47.41 ± 24.3 min) than in Group TAP (27.41 ± 11.9 min) and Group SWI (16.67 ± 5.1 min). Patient satisfaction scores were significantly higher at 24 and 48 hours in Group LEA (9.89 ± 0.3 and 9.96 ± 0.1, respectively) than in Group TAP (9.67 ± 0.5 and 9.89 ± 0.3) and Group SWI (9.37 ± 0.8 and 9.44 ± 0.7). No significant side effects were noted. Conclusion: In patients undergoing major gynecologic surgery, LEA resulted in lower morphine consumption, longer time to first rescue analgesic request, and higher patient satisfaction scores without increasing the risk of side effects compared to TAP block and SWI.