Comparative Study Between Lumbar Epidural Versus Transversus Abdominis Plane Block For Postoperative Analgesia After Lower Abdominal Surgeries

Background: Postoperative pain is a potent cause of adverse effects in many organ systems thus anterior abdominal wall analgesia after abdominal surgery may assist in improving postoperative outcome. The analgesic regimen needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma -induced nociceptive impulses. Aim of the work: to compare the analgesic efficacy of transversus abdominis plane block with lumber epidural analgesia for postoperative pain relief following lower abdominal surgeries. Patients and methods: The present study was carried out at Al-Azhar University Hospitals (Al-Hussien and SayedGalal) after institutional ethics and informed consent. 90 adult patients were randomized into three groups (30 patients in each group): Lumbar epidural group, Transversus abdominis plane block group and A Control group. Results: As regards postoperative hemodynamic data, higher readings appeared within the control group, while the epidural group and TAP group showed lower readings with no statically difference among the three groups, except at the first 10 minutes and 20 minutes time periods after starting the epidural analgesia and application of the TAP block. As regard pain scoring using the visual analog scale (VAS), the results showed no statically difference among the three groups with (P>0.05), except at the first 10 minutes and 20 minutes time periods after starting the epidural analgesia and application of the TAP block, highest readings were realized among the control group at these two time periods in comparison with the other two groups with P<0.05. Patients of the control group were the first to ask for rescue analgesia. Rate of administration of the rescue analgesia was seen to be more frequent among patients of the control group rather than the other two groups with (P<0.05).Postoperative complications as, (nausea and vomiting) which occurred due to systemic use of opioids were mostly seen among the control group rather than the other two groups with (P<0.05) Conclusion: Use of the TAP block proved to be a simple and safe procedure in providing effective reliable analgesia, together with reduction of postoperative pain scores, both at rest and knee flexion, and postoperative opioid requirements thus avoided any of the systemic side effect of opioid such as PONA as seen among the control group. Recommendations: The blind application of this technique might have been associated with major complication although we didn’t experienced any, yet performing this block under ultrasound guidance facilitates identification of the needle tip in the TAP, and may result in reduced risk, particularly in obese patient with BMI > 30 kg/m².