Evaluation of postoperative analgesic efficacy of ultrasound guided transversus abdominis plane block plus iv diclofenac versus iv diclofenac in lower abdominal surgeries

Introduction: After lower abdominal surgeries, postoperative discomfort and pain can be anticipated. The provision of effective postoperative analgesia is of key importance to facilitate early ambulation, reduce pain on physical straining such as coughing, avoid emotional stress and prevention of postoperative morbidity. The use of TAP block,in lower abdominal surgeries is relatively less common. This may be attributed to the usage of ilioinguinal-iliohypogastric (IHN) block, However, after IHN block, the duration of the block is not prolonged enough to allow pain control during all the postoperative period .Also, the reliability of the technique is variable as it is performed blindly and the incidence of peritoneal puncture and consequent peritonitis is considerable. In this context, our study was designed to hypothesize that an ultrasound guided TAP block in addition to conventional analgesics may improve pain relief after lower abdominal surgeries, thus, facilitating early ambulation and improved patient satisfaction. Material and methods: 74 male patients belonging to ASA grade I and II physical status, scheduled for lower abdominal surgeries under spinal anaesthesia were randomized into 2 groups of 37male patients each, using a computer generated random number table- • Spinal anesthesia plus postoperative TAP block and IV diclofenac (Group A), and, • Only spinal anesthesia without TAP block and only IV diclofenac (Group B). Results: Both groups were comparable with respect to age, ASA grade, weight and duration of surgery. Patients who received TAP block had a longer time to first rescue analgesic request (tramadol) and lesser total rescue analgesic requirement over 24 hrs when compared to patients who did not receive the block. The total tramadol requirement over 24 hrs was 133 mg in control group as compared to 73 mg in patients who received TAP block. Addition of ultrasound guided TAP block to conventional analgesics thus prolonged the duration of analgesia approximately by more than two hours and also reduced total tramadol requirement by nearly half, thus reducing nausea. Conclusion: The present study demonstrated that the addition of ultrasound guided TAP block to conventional analgesics (IV Diclofenac) following lower abdominal surgeries prolonged the time to first rescue analgesic request and reduced total opioid requirements postoperatively.