Comparison of Postoperative Analgesic Efficacy of TAP Block and TFP Block in Patients Undergoing Abdominal Hysterectomy

Hacettepe University

Status: Completed

Conditions: Hysterectomy, Benign Uterine Diseases; Abdominal Pain (AP)

Treatments: Device: High Frequency Linear Probe (GE Logic e R7 Ultrasonography Device, USA)

Study type: Interventional

Funder types: Other

Identifiers

NCT06853782

KA-22062

Details and patient eligibility

About

Total abdominal hysterectomy is one of the most commonly performed surgeries in women and is known to cause significant pain in especially early postoperative period. The goal of this clinical trial is to compare analgesic efficiacy of TAP block, which is well established by studies in hysterectomy surgeries, and TFP block, a relatively new block with good analgesic effect when used for lower abdominal surgeries, in patients undergoing abdominal hysterectomy surgery.The main parameters to compare the analgesic efficiacy of TAP and TFP blocks are;

1. Pain scores in motion
2. Opioid consumption

Researchers will apply the lateral TAP block and TFP block, prepare the postoperative analgesic treatment regimen and record the patients' analgesic consumption, make ward visits and ask patients about their pain intensity and check for opioid consumption and associated side effects, block-related complications, mobilization, length of hospital stay, and patient satisfaction in patients undergoing elective total abdominal hysterectomy surgery.

Participants will score the pain they feel in motion with certain pain scales.Participants will also respond to the researchers' questions for other parameters in study.

Full description

Total abdominal hysterectomy is a commonly performed surgical procedure in women that involves the surgical removal of the uterus and is known to cause significant pain, especially during the early postoperative period.

This study aims to prospectively compare the effects of lateral TAP block and TFP block in patients undergoing elective total abdominal hysterectomy with Pfannenstiel incision under general anesthesia for benign uterine neoplasms in a randomized controlled manner.

The TAP block is a fascial plane block targeting the trunkal T6-T12/L1 nerves located between the internal oblique and transversus abdominis muscles and is an effective regional anesthesia method for abdominal surgeries. In patients undergoing total abdominal hysterectomy, TAP block significantly reduces opioid consumption during the postoperative period and results in marked decreases in pain scores at rest and during movement without causing side effects.

The TFP block is a regional analgesia method used in lower abdominal surgeries targeting the branches of the trunkal T12-L1 nerves, located between the transversus abdominis muscle and transversalis fascia. While the TAP block covers dermatomes from T6-L1, the TFP block targets dermatomes T12-L1. A significant difference from the TAP block is that the TFP block provides effective analgesia in areas innervated by the lateral cutaneous branches emerging from the L1 dermatome that TAP block may not fully cover.

Enrollment: 77 patients

Sex: Female

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• ASA scores of 1-2
• Adults aged 18+ years
• Diagnosed with benign uterine neoplasms and will undergo elective total abdominal hysterectomy via Pfannenstiel incision under general anesthesia
• Agreed to participate in the study will be included.

Exclusion criteria

• Patients with known

  • Neuropathy
  • Renal failure
  • Hepatic failure
  • Coagulopathy

• Skin infection at the site of intervention

• Allergy to local anesthetics

• BMI > 35 kg/m²

• Hysterectomy surgery extended due to malignancy or multiple surgeries during the same hospitalization

• Emergency surgeries

• ASA scores of 3-4

• Emergency surgery

• Patients who do not consent to participate in the study will be excluded.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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77 participants in 2 patient groups

TAP Block Group

Active Comparator group

Description:

In the TAP block group, the lateral transversus abdominis plane block will be performed by the anesthesiologist under ultrasound guidance using a linear probe after the completion of the surgery. Patients will receive 40 ml of 0.25% bupivacaine, administered in two equal doses, into the fascial plane between the internal oblique muscle and the transversus abdominis muscle on both sides.

Treatment:

Device: High Frequency Linear Probe (GE Logic e R7 Ultrasonography Device, USA)

Device: High Frequency Linear Probe (GE Logic e R7 Ultrasonography Device, USA)

TFP Block Group

Active Comparator group

Description:

In the TFP block group, the transversalis fascia plane block will be performed by the anesthesiologist under ultrasound guidance using a linear probe after the completion of the surgery. Patients will receive 40 ml of 0.25% bupivacaine, administered in two equal doses, between transversus abdominis muscle and transversalis fascia on both sides.

Treatment:

Device: High Frequency Linear Probe (GE Logic e R7 Ultrasonography Device, USA)

Device: High Frequency Linear Probe (GE Logic e R7 Ultrasonography Device, USA)