Comparison of thoracic paravertebral block and transversus abdominis plane block for postoperative analgesia in major gynecologic surgery: A single blind randomized controlled clinical trial

• Published in: International journal of surgery open Vol. 25; pp. 35 - 40
• Main Authors: Ali, Siraj Ahmed, Ayalew, Nugusu, Tesfaye, Tizalegn, Jemal, Bedru, Mekonnen, Semagn, Mohammed, Ayub
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 2020
• Subjects: Analgesic consumption; Major gynecologic surgery; Postoperative pain; Thoracic paravertebral block; Transversus abdominis plane block; Analgesic consumption; Postoperative pain; Transversus abdominis plane block; Major gynecologic surgery; Thoracic paravertebral block
• ISSN: 2405-8572; 2405-8572
• DOI: 10.1016/j.ijso.2020.06.004

Patients after major gynecologic surgeries experience moderate to severe pain, which needs pharmacological intervention. Different regional blocks are now a days introducing as components of multimodal analgesia for pain management. Even though transversus abdominis plane block and paravertebral block were described for postoperative analgesia in abdominal surgeries, data comparing these blocks for gynecologic surgery is limited.
The aim of this single blind randomized controlled trail was to compare thoracic paravertebral block and transversus abdominis plane block for postoperative analgesia in patients underwent gynecologic surgery under general anesthesia.
Thirty four patients with American society of anesthesiologists physical status I and II, age between 18 and 65 years underwent gynecologic surgery under general anesthesia were randomly allocated in thoracic paravertebral group or transversus abdominis plane block group. Patients' pain intensity with numerical rating score, time to first analgesic time and total rescue analgesic/tramadol consumption were documented by data collectors who were unaware of the block done for the patents during the first 24 ours postoperatively.
Time to first analgesic request was lower in thoracic paravertebral group than transversus abdominis plane group but not statistically significant (p = 0.057). Median numerical rating scale score was significantly lower in thoracic paravertebral group than transversus abdominis plane group at post anesthesia care unit admission (p = 0.016). Time taken to perform the block was significantly higher in thoracic paravertebral group than transversus abdominis plane group (p < 0.001).
Both thoracic paravertebral block and transversus abdominis plane block were effective for postoperative analgesia in women underwent gynecologic surgery under general anesthesia. Although thoracic paravertebral block appeared to be as effective as transversus abdominis plane block, it took longer time to perform the block.
•Thoracic paravertebral block at single site is effective analgesia for major gynecologic surgery.•Transversus abdominis plane block can be safely performed for postoperative analgesia in gynecologic surgery.•Thoracic paravertebral block in single site significantly reduces postoperative analgesic consumption.•Single site thoracic paravertebral block increases the time to first analgesic request time after surgery.