A Comparative study between Transverse abdominus planes block and wound site local anesthesia infiltration for effective post operative pain control for lower abdominal surgery at Empress Zewditu memorial Hospital, Addis Ababa, Ethiopia 2017/18.
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Date
2018-06
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Addis Ababa Universty
Abstract
Introduction: Wound site infiltration with local anesthesia is a technique commonly used alone or in combination to improve postoperative analgesia, reduce opoid consumption and speed patient recovery.TAP block also reduces morphine requirements by more than70% and consequently reduces opioid-mediated side effects provides highly effective postoperative analgesia in the first 24–48 hours.
Objective: To compare the analgesia effectiveness of Transvurse abdominus plane blocks and wound site local anesthesia infiltration for post operative pain for lower abdominal procedure under general anesthesia at Zewditu memorial Hospital from Jan 1, 2018-March 30, 2018 Addis Ababa Ethiopia.
Methods: This prospective cohort study recruits 60 American Society of Anesthesiologist (ASA) class I and II, age ≥ 18 and patient who underwent lower abdominal procedures randomly. Data were analysed by using SPSS version 20. Demographic data were analyesed using student t test (for normal distribution variable ) and Chi square and Fisher’s exact test (for categorical variable). The data were tested for normality using the Shapiro-Wilk normality test .There was homogeneity of variance assessed by Levene’s Test for equality of Variances. Therefore, Manny Whitny U test was run on the non- normally distributed data for the time of first analgesic request & total analgesic consumption. Since the VNRS ordinal variable Mann-Whitney U test were used. Normal distributed data were presented as mean ± SD, not normally distributed data were presented as median (IQR) and categorical data were presented frequency percentages .A P value <0.05 considered as statistically significant.
Results: The comparison of data showed that statistically significant result during recovery room (PACU) time the Median and IQR of postoperative pain score(NRS) were 2(2-3) in Infiltration group and 4(4-5) in TAP group (p<0.001) and at 1st hour with the Median and IQR of postoperative pain score(NRS) were 2(2-2) in Infiltration group and2(2-3) in TAP group (p-0.014).There was no statistically significant difference results at 2nd hr and 24th hour between two group and there were statistically significant difference at 4th ,6th and 12th hour showing lower Median pain score in TAP group compared to infiltration group. The Median and IQR for time to first analgesia request in minutes were longer 673(620-765) minutes in TAP group compared to 227(195-235) minutes in Infiltration group (p< 0.001).The Median and IQR for Tramadol consumption within 24 hour was 100 mg(100-100) in TAP group compared to 175 mg(150-200) in infiltration group(p<0.001).
Conclusion and Recommendation: TAP group shows extended pain relief up to 12 hour; prolong time to first analgesia request and less total analgesia consumption for lower abdominal procedures done under general anesthesia. Based on this finding we recommend that use of TAP block is for effective Postoperative analgesia.
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Keywords
Local anesthesia infiltration, Transverse abdominal plane block