Effectiveness of Ultrasound Guided Transversus Abdominis Plane Block in Pelvic Gynaecological Surgery at Kenyatta National Hospital

Abstract

Background: Goals of postoperative pain management are to relieve suffering, achieve early mobilization, prevent postoperative complications, reduce length of hospital stay, achieve patient satisfaction and prevent chronic pain syndromes. Regional anaesthesia reduces the risk of chronic pain post-surgery compared to conventional pain control. A multimodal approach to adequate post-operative analgesia includes regional blocks of the anterior abdominal wall and local infiltration of the incision site. There is an increased risk of DVT in pelvic surgery and therefore the need to ambulate as soon as possible. Inadequate post-op pain management especially during the first 24hrs has been associated with development of chronic pain syndromes. Objectives: To assess post-operative pain relief following pelvic gynaecological surgeries using TAP block at KNH for the first 24 hours Methodology: This study adopted an observational study design involving adult women undergoing elective pelvic gynaecological surgery at KNH for a period of 3 months. It assessed the pain scores of the respondents immediately after the surgery and a follow up for at 6,12,18,24 hours post operatively, time to ambulation and need for rescue analgesia. It utilized 43 adult women. Data was collected using questionnaires administered by the researcher with the help of trained research assistants. All data collected in the study was sorted, coded and entered in a computer using SPSS version 20. Descriptive statistics such as mean, median and measures of dispersion were used to describe the VAS scores of the patients receiving TAP block while frequencies and percentages were used to describe analgesic requirements and time to ambulation. The study findings were presented using figures, tables, pie-charts and bar-graphs. Results: The overall average pain score was 2(mild pain) and the average time to request analgesia was 9 hours post operatively .12 patients did not request for rescue analgesia therefore reducing their opioid requirements.33 patients requested for analgesia 15 were given tramadol 9 morphine and 6 paracetamol .3 were not given.The average time to complete ambulation was noted to be 18 hours. Nausea, Vomiting and Diarrhoea were the side effects experienced post operatively, though they are more likely to be attributed to the anaesthetics and analgesics given. Conclusion: single shot bilateral ultrasound guided TAP block for pelvic gynaecological surgery given together with conventional analgesics is effective in reducing pain scores for 8 to 12hrs post operatively, reduce opioid requirement, reduce rest and movement pain encouraging early ambulation with minimal side effects.

Recommendations: Routine use of ultrasound guided TAP block together with conventional analgesics for post operative pain management with availability of the necessary equipment needed for performing the block. Perform a Randomized Controlled Trial to compare the effectiveness of post operative pain control between the conventional analgesics and the TAP block.