title: Comparison of the analgesic effect between continuous wound infiltration and single-injection transversus abdominis plane block after gynecologic laparotomy.
abstract: OBJECTIVE
  Both single-injection transversus abdominis plane (TAP) block and continuous wound infiltration (CWI) provide postoperative analgesia, but no study has compared the two regional techniques. We tested the hypothesis that CWI is more effective for controlling postoperative pain compared with single-injection TAP block after laparotomy.
  
  
  METHODS
  We conducted a prospective randomized study of patients undergoing gynecologic laparotomy with midline incision through the umbilicus under general anesthesia. The patients were allocated to receive either single-injection TAP block (TAP group) or CWI (CWI group) for postoperative analgesia. All patients received intravenous patient-controlled analgesia with morphine and intravenous flurbiprofen twice daily after surgery. Postoperative pain at rest and on coughing, postoperative morphine consumption, incidence of postoperative nausea and vomiting (PONV), pruritus and urinary retention, ambulation, and satisfaction score were recorded. Patients were assessed at 3 h after surgery and twice daily on postoperative days (POD) 1 and 2.
  
  
  RESULTS
  Data of 54 patients were analyzed. Compared to the TAP group (n = 27), pain score on coughing was significantly lower in the CWI group (n = 27) on POD1 and POD2 (P < 0.05). Pain score on coughing at 3 h after surgery, pain score at rest at all assessed time points, morphine consumption, incidence of PONV, pruritus and urinary retention, ambulation, and satisfaction score were not different between the two groups.
  
  
  CONCLUSIONS
  CWI reduced pain on coughing after the day of surgery compared with single-injection TAP block when performed as part of multimodal analgesia in patients undergoing gynecologic laparotomy.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. hottak@jichi.ac.jp.
authors.forename: Kunihisa
authors.initials: K
authors.lastname: Hotta
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.|Department of Anesthesiology, St. Marianna University School of Medicine, Kanagawa, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Inoue
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Taira
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Naho
authors.initials: N
authors.lastname: Sata
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tamai
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Takeuchi
mesh_terms: D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007267:Injections; D007813:Laparotomy / Q000379:methods*; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Abdominal surgery; Continuous wound infiltration; Postoperative analgesia; Transversus abdominis plane block