title: Ultrasound-guided transversus abdominal plane block with multimodal analgesia for pain management after total abdominal hysterectomy.
abstract: BACKGROUND
  Transversus abdominis plane (TAP) block has been shown to provide pain relief after abdominal procedures. However, TAP block combined with multimodal analgesia technique have not been assessed in a randomized controlled trial. This randomized, controlled, observer-blinded study was designed to evaluate the analgesic efficacy of bilateral ultrasound-guided TAP blocks with or without acetaminophen and non-steroidal anti-inflammatory drug (NSAID) combination.
  
  
  METHODS
  Patients undergoing total abdominal hysterectomy were randomized to one of three groups. Group 1 (n = 25) received a TAP block and ketorolac 30 mg, IV at the end of surgery and then ketorolac plus paracetamol 650 mg, orally, every 6 h for 24 h. Group 2 (n = 24) received only TAP block at the end of surgery. Group 3 (n = 25) received ketorolac 30 mg, IV at the end of surgery and then ketorolac plus paracetamol 650 mg, orally, every 6 h for 24 h. All patients received IV-PCA morphine for 24-h, postoperatively. All patients received a standardized general anaesthetic technique and dexamethasone 4 mg and ondansetron 4 mg, IV for antiemetic prophylaxis.
  
  
  RESULTS
  There were no statistically significant differences in pain at rest between the groups. However, the pain on coughing (dynamic pain) in Group 1 was significantly less variable, compared with the other two groups (P = 0.012). Opioid consumption and occurrences of nausea, vomiting, and rescue antiemetic were similar in three the groups.
  
  
  CONCLUSIONS
  The combination of TAP block and acetaminophen and NSAID provided less variability in dynamic pain compared with either treatment alone.
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9068, USA. irina.gasanova@utsouthwestern.edu
authors.forename: Irina
authors.initials: I
authors.lastname: Gasanova
authors.forename: Erica
authors.initials: E
authors.lastname: Grant
authors.forename: Megan
authors.initials: M
authors.lastname: Way
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rosero
authors.forename: Girish P
authors.initials: GP
authors.lastname: Joshi
mesh_terms: D000009:Abdominal Muscles / Q000000981:diagnostic imaging; D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D016058:Analgesia, Patient-Controlled; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002045:Bupivacaine; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D020910:Ketorolac / Q000627:therapeutic use; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009325:Nausea / Q000139:chemically induced; D009407:Nerve Block; D059408:Pain Management / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D016037:Single-Blind Method; D018084:Ultrasonography, Interventional; D014839:Vomiting / Q000139:chemically induced
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D009020:Morphine; D002045:Bupivacaine; D020910:Ketorolac