Observational Study to Evaluate Transversus Abdominis Plane (TAP) Block in Abdominal Surgery by Total Requirement of Diclofenac as a Post Operative Analgesia drug

Abstract

Background: Transversus Abdominis Plane Block (TAPB) is a regional anesthesia technique.It provides analgesia after lower abdominal surgery particularly where parietal wall pain forms major component of pain. It allows sensory blockade of lower abdominal wall skin and muscles via local anesthetic deposition between Transversus Abdominis muscle and internal oblique muscle. We evaluated efficacy of unilateral TAPB with bupivacaine for postoperative analgesia in hernia repair in a hospital based, double blind, and prospective, randomized controlled clinical trial. Method: 60 patients undergoing elective unilateral inguinal hernioplasty surgery were randomized to undergo TAPB with bupivacaine (n =30) in study group and without TAPB in control group (n=30). At end of surgery performed under spinal anesthesia unilateral TAPB on side of surgery was performed using 20 ml of 0.25 % bupivacaine in study group. Each patient was assessed postoperatively by a blinded investigator in post-anesthesia care unit at 30 min., 2, 4, 6, 12, 18, 24 hours. The time required for first dose of rescue analgesia, vas score, total consumption of diclofenac was assessed in each group and comparison were performed by student t-test. Result: Mean duration of analgesia was 669.66 minutes with SD of +346 in study group and 220.33 minutes with SD of +139.24 in control group which was found to be statistically significant. VAS score was significantly higher in control group as compared to the study group at all the time. Total dose of diclofenac consumption in study group was 9533.73mg and in control group it was 202.544.69mg, which showed that diclofenac consumption was significantly decreased in study group. Conclusion: TAPB with 0.25% bupivacaine provided potent and longer duration of analgesia, with very less requirement of diclofenac when used in patients of inguinal hernioplasty. There were no complications attributable to TAPB or drugs under study.