[Postoperative numerical rating scale in patients undergoing gynecological laparotomy under general anesthesia combined with either single epidural injection or transverses abdominis plane block].

BACKGROUND: After the operation, early postoperative ambulation has been recommended for thromboprophylaxis. As more anticoagulant drugs have become available, hemorrhagic complication of epidural anesthesia is the focus of attention. Recently, the spread of ultrasound-guided nerve block has improved the efficacy of the transversus abdominis plane block Therefore, we compared transversus abdominis plane block with epidural anesthesia regarding postoperative numerical scale in patients undergoing gynecological surgery.

METHODS: Doses of administrated narcotics during anesthesia, frequencies of administration of analgesics and vomiting up to 24 hours postoperatively, and numerical rating scale (NRS) at the first and 18th postoperative hours were retrospectively surveyed in patients undergoing gynecological laparotomy. Anesthesia was maintained with sevoflurane combined with either single epidural injection of 6-12 ml of 0.375- 0.75% lopivacaine with 2-4 mg of morphine in 16 patients (Epi group) or ultrasound-guided transverses bilateral abdominis plane block (TAPB) using 20 ml of 0.375% lopivacaine, respectively, in 16 patients (TAP group).

RESULTS: No significant differences were found in age, height, weight, ASA-physical status, volume of intraoperative blood loss and surgical time. Both the total administrated doses of remifentanil and fentanyl during anesthesia in TAP group were significantly larger than those in Epi group. Number of postoperative vomiting was larger in Epi group. However, NRS at the postoperative first and 18th hours showed no significant differences between the two groups. The technique of ultrasound-guided TAPB is relatively easy compared with that of epidural injection and TAPB has an advantage in availability in patients receiving anticoagulant therapy.

CONCLUSIONS: No significant difference in postoperative NRS between two groups in this survey suggests that TAPB in combination with appropriate postoperative pain service is useful in patients contraindicated to epidural puncture.