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Indian Journal of Anesthesia and Analgesia

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Comparison of 0.375% Bupivacaine in Tranversus Abdominal Plane Block Versus Epidural Block for Post-Operative Analgesia

Gayatri Khanvelkar, Senior Resident, Department of Anaesthesiology, Dr. D Y Patil Medical College, Hospital and Research Centre. Pimpri, Pune, Maharashtra 411018, India. , J.N. Lakhe1 , Gayatri Khanvelkar2 , Suhit Natekar3 , Adnan Qadri4

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Indian Journal of Anesthesia and Analgesia 5(9):p 1493-1501, September 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5918.11

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Abstract

Epidural analgesia by administration of bupivacaine has been considered as the Gold Standard for management of postoperative pain. On the other hand there is a paucity of literature on the efficacy of bupivacaine administered by Transversus Abdominis Plane (TAP) for postoperative pain relief in patients undergoing infra umbilical abdominal surgeries. The present study was carried out in a tertiary care medical college hospital in a rural setting to compare the efficacy of 0.375% Bupivacaine in the control of postoperative pain in patients undergoing infra umbilical abdominal surgeries when used in epidural space versus in the TAP.

Material and Methods: Sixty patients between 20 to 60 years of age of either sex in ASA grade I or II undergoing infra umbilical abdominal surgeries were divided into two groups of 30 each depending upon the route of administration of 0.375% bupivacaine either though TAP (Group T) or through epidural space (Group E). The parameters studied were variations in haemo-dynamics, quality of analgesia by VAS score, duration of analgesia by request for rescue analgesics, adverse effects if any and finally patient satisfaction for the postoperative pain relief.

Results: The Heart Rate (HR), Mean Arterial Pressure (MAP), Respiratory Rate (RR) and Oxygen Saturation (SpO2) were comparable between both the groups throughout the postoperative period with no significant change in haemodynamics from the baseline. The quality of postop analgesia in Group T was significantly better than in Group E as observed by lower VAS Scores at rest at various time intervals in Group T as compared to Group E ( p<0.05). Considerably higher scores for patient satisfaction for postoperative pain relief were observed in Group T as compared to Group E after 48 hours of administration of the study drug. (p<0.05). Considerably longer duration of postop analgesia was observed in Group T (420.03±30.42) as compared to Group E (240.27±30.1) which was statistically significant (p<0.05).

Conclusion: 0.375% bupivacaine is effective for postoperative analgesia in both the groups however TAP block holds considerable promise for patients undergoing infra umbilical surgeries and is an efficient alternative to epidural analgesia on account of its efficacy, safety, affordability and simplicity.

 

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5918.11

Keywords

Postoperative Analgesia; Transversus Abdominis Plane Block; Epidural Analgesia; Infra Umbilical Surgical Procedures.

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