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2020 Month : March Volume : 9 Issue : 9 Page : 634-640,

Comparison of Epidural Analgesia vs Continuous Transversus Abdominis Plane Analgesia for Post-Operative Pain Relief in Patients Undergoing Lower Abdominal Surgery.

Ramesh Kumar N.1

Corresponding Author:
Dr. Ramesh Kumar N.,
A-1, No. 25, Ashirwad Residency,
RMV 2nd Stage, Lottegollahalli,
New Ramaiah Compound,
Bangaluru-94, Karnataka, India.
E-mail: rameshnareppa@gmail.com

ABSTRACT

BACKGROUND

Regional Anaesthesia for post-operative analgesia has become an important tool in the anaesthetist’s arsenal. Epidural analgesia has become a standard of care for abdominal surgeries; however, it has its own complications. Further, many patients cannot benefit from it when contraindicated. Transversus Abdominis Plane (TAP) block is a relatively new technique of regional anaesthesia which has the potential to be an alternative to Epidural analgesia for abdominal surgeries. However, it remains a yet poorly explored technique. This is more so in the case of continuous TAP Blocks by means of a catheter. Few studies have been done comparing it with epidural analgesia.

METHODS

72 patients undergoing lower abdominal surgery under spinal anaesthesia were randomized to receive epidural anaesthesia with 10 ml 0.125% Bupivacaine 8th hourly or TAP Block with 20 ml 0.125% Bupivacaine on each side 8th hourly. VAS scores at rest and on coughing, consumption of Paracetamol (first rescue analgesic) and consumption of Tramadol (second rescue analgesic) were recorded along with heart rate, blood pressure and respiratory rate.

RESULTS

VAS scores at rest were comparable between the groups in the first 16 hours. However, at 24 and 48 hours, the TAP Block group had significantly higher VAS scores at rest. Similar results were seen for the VAS score on coughing. The first 8 hours were comparable between the groups, beyond which, VAS scores were significantly higher in the TAP Block Group. Analgesic consumption reflected the same with paracetamol (first analgesic) consumption being comparable throughout the study, however, the consumption of tramadol (second rescue analgesic) was significantly higher in the TAP block group at the end of 24 as well as 48 hours.

CONCLUSIONS

The findings suggest that Analgesia with Epidural as well as with continuous TAP Block at 8th hourly bolus dosing of 0.125% Bupivacaine in patients undergoing lower abdominal surgeries is comparable in the first 8 to 16 hours. However, the quality of analgesia provided by the TAP Block catheter is inferior to that provided by epidural catheters beyond 24 hours post-operative period.

KEY WORDS

Regional Anaesthesia, Post-Operative Analgesia, Transversus Abdominis Plane Block, Epidural Analgesia, Bupivacaine, Catheter-Based Techniques

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