European Journal of Anaesthesiology | 2021
Bilateral mid-axillary transversus abdominis plane block does not attenuate stress response to total abdominal hysterectomy: A randomised controlled placebo trial.
Abstract
BACKGROUND\nThe hormonal response to surgical trauma can have detrimental effects on patients. Transversus abdominis plane (TAP) block, which can improve analgesia after total abdominal hysterectomy (TAH) might attenuate the peri-operative stress response.\n\n\nOBJECTIVE\nTo evaluate the ability of the TAP block to reduce stress response, opioid consumption and pain following TAH and multimodal analgesia.\n\n\nDESIGN\nRandomised, placebo-controlled double-blind study.\n\n\nSETTING\nThe current study was conducted at a university hospital from July 2016 to September 2017.\n\n\nPATIENTS\nFifty patients scheduled for TAH were included. Anaesthesia and postoperative analgesia were standardised.\n\n\nINTERVENTION\nAfter induction of anaesthesia, patients were allocated into two groups: ultrasound-guided bilateral mid-axillary TAP block with 20\u200aml of bupivacaine 0.25% (Group T) or 0.9% saline (Group C).\n\n\nMAIN OUTCOME MEASURES\nLevels of free serum cortisol, metanephrine and normetanephrine at 60\u200amin and 6, 12 and 24\u200ah after surgical incision. Pain scores and opioid consumption during the first 24\u200ah after surgery.\n\n\nRESULTS\nThere was no statistically significant difference between the median [IQR] peri-operative levels of stress hormones and pain scores between groups. Compared with baseline value 9.90 [4.2 to 23.1], free serum median cortisol levels were significantly high at 6\u200ah in Group T, 23.6 [10.1 to 42.9] P\u200a=\u200a0.015 and Group C 23.6 [9.9 to 46.3] P\u200a=\u200a0.014. Only Group C showed significant elevation from the baseline median levels of plasma metanephrine at 60\u200amin, 52.8 [33.4 to 193.2] P\u200a=\u200a0.001, 6\u200ah, 92.70 [2.4 to 202.6] P\u200a=\u200a0.005 and normetanephrine at 60\u200amin 83.44 [28.98 to 114.86] P\u200a=\u200a0.004, 6\u200ah 78.62 [36.6 to 162.31] P\u200a=\u200a0.0005 and 24\u200ah 80.96 [8.6 to 110.5] P\u200a=\u200a0.025. Mean\u200a±\u200aSD opioid consumption was similar in both groups: 39.60\u200a±\u200a14.87 in Group T vs. 43.68\u200a±\u200a14.93 in Group C (P\u200a=\u200a0.338).\n\n\nCONCLUSION\nMid-axillary TAP block does not improve stress response and analgesia in patients undergoing TAH receiving multimodal analgesia.\n\n\nTRAIL REGISTRATION\nClinicalTrial.gov identifier: NCT03443271.