A clinical study to assess the requirement of analgesia post usg guided bilateral transversus abdominis plane block with 0.25% bupivacaine AND 0.25% bupivacaine with 50µG fentanyl following total abdominal hysterectomy under general anesthesia

Background: Different adjuvant drugs have been used to improve the quality and increase the duration of local anesthetics during various nerve block techniques. More recently ultrasound-guided TAP block has been described with promises of better localisation and deposition of the local anaesthetic with improved accuracy. The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents. Objective: To assess the requirement of analgesia post USG guided bilateral transversus abdominis plane block with 0.25% bupivacaine and 0.25% bupivacaine with 50µg fentanyl following total abdominal hysterectomy under general anesthesia. Methods: This clinical study is conducted in the Department of Anaesthesiology and Critical care, Pt. J. N. M. Medical College and Dr. Bhim Rao Ambedkar Memorial Hospital, Raipur (C.G.) from 01/04/2014 to 22/09/2015. Results: The time to first request for analgesic came at 4th and 12th hr in group B and F respectively. The difference for the time of first request of analgesic between the two groups was statistically significant (p <0.05). Total no. of patients who used analgesic in 24 hrs duration was 19 (95%) and 15 (75%) in group B and F respectively. The difference of mean usage of i.v. paracetamol between the two groups was statistically significant (p <0.05). In group B i.v. tramadol was used once by 3 patients, twice by 14 patients whereas no analgesic supplementation was required in 16 patients. The difference in the i.v. tramadol requirement between the 2 groups was statisticaly significant (p < 0.05). Conclusion: Addition of small dose of fentanyl to bupivacaine for bilateral ultrasound-guided transversus abdominis plane (TAP) block improves analgesia and prolonges the time to first analgesic requirements and decreases the need for postoperative analgesics in patients undergoing total abdominal hysterectomy with no remarkable side effects. IV paracetamol and IV tramadol gave great results as analgesics.