title: Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Laparoscopic Hysterectomy: A Randomized, Controlled, Observer-Blinded Trial.
abstract: In this randomized, controlled, observer-blinded study, we evaluated analgesia provided by transversus abdominis plane (TAP) block after elective total laparoscopic hysterectomy in terms of reduced postoperative morphine consumption as the primary end point.
  
  
  
  Fifty-two patients were randomly divided into 2 groups: patients in group T (TAP, n = 26) received an ultrasound-guided bilateral TAP block with 40 mL of 0.375% levobupivacaine and morphine patient-controlled analgesia, whereas patients in group C (control, n = 26) received morphine patient-controlled analgesia. Secondary outcomes included pain measurements (Numeric Rating Scale from 0 to 10) during the first 24 hours postoperatively, times to postanesthesia care unit discharge, times to surgical ward discharge, incidence of postoperative nausea and vomiting, functional capacity measurements in terms of 2-minute walking test, and first oral solid intake.
  
  
  
  Demographic and anthropometric variables were similar in the 2 groups. The total dose of morphine consumed by patients during postanesthesia care unit stay was 6 (0-8) mg in group T vs 8 (5.5-8.5) mg in group C (P = 0.154). Postoperative morphine consumption during the first 24 hours was 10.55 ± 10.24 mg in group C vs 10.73 ± 13.45 mg in group T (P = 0.950). The 95% confidence interval of the difference between means of 24-hour morphine consumption was -7.45 to +7.09. The 2 groups were comparable. There were no significant differences in secondary outcome variables between groups.
  
  
  
  TAP block did not reduce morphine consumption during the first postoperative 24 hours after elective total laparoscopic hysterectomy.
authors.affiliation: From the *Department of Anesthesia and Perioperative Medicine, Istituti Ospitalieri di Cremona, Cremona, Italy; †Department of Gynaecology and Obstetrics, Istituti Ospitalieri di Cremona, Cremona, Italy; and ‡Department of Anesthesia, Intensive Care and Pain Therapy, University Hospital Parma, Parma, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Ghisi
authors.forename: Andrea
authors.initials: A
authors.lastname: Fanelli
authors.forename: Federico
authors.initials: F
authors.lastname: Vianello
authors.forename: Marco
authors.initials: M
authors.lastname: Gardini
authors.forename: Giulio
authors.initials: G
authors.lastname: Mensi
authors.forename: Luca
authors.initials: L
authors.lastname: La Colla
authors.forename: Giorgio
authors.initials: G
authors.lastname: Danelli
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation*; D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects*; D000077554:Levobupivacaine; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects*; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077554:Levobupivacaine; D002045:Bupivacaine