Total abdominal hysterectomy is one of the most commonly performed surgeries in women and is known to cause significant pain in especially early postoperative period. The goal of this clinical trial is to compare analgesic efficiacy of TAP block, which is well established by studies in hysterectomy surgeries, and TFP block, a relatively new block with good analgesic effect when used for lower abdominal surgeries, in patients undergoing abdominal hysterectomy surgery.The main parameters to compare the analgesic efficiacy of TAP and TFP blocks are; 1. Pain scores in motion 2. Opioid consumption Researchers will apply the lateral TAP block and TFP block, prepare the postoperative analgesic treatment regimen and record the patients' analgesic consumption, make ward visits and ask patients about their pain intensity and check for opioid consumption and associated side effects, block-related complications, mobilization, length of hospital stay, and patient satisfaction in patients undergoing elective total abdominal hysterectomy surgery. Participants will score the pain they feel in motion with certain pain scales.Participants will also respond to the researchers' questions for other parameters in study.
Total abdominal hysterectomy is a commonly performed surgical procedure in women that involves the surgical removal of the uterus and is known to cause significant pain, especially during the early postoperative period. This study aims to prospectively compare the effects of lateral TAP block and TFP block in patients undergoing elective total abdominal hysterectomy with Pfannenstiel incision under general anesthesia for benign uterine neoplasms in a randomized controlled manner. The TAP block is a fascial plane block targeting the trunkal T6-T12/L1 nerves located between the internal oblique and transversus abdominis muscles and is an effective regional anesthesia method for abdominal surgeries. In patients undergoing total abdominal hysterectomy, TAP block significantly reduces opioid consumption during the postoperative period and results in marked decreases in pain scores at rest and during movement without causing side effects. The TFP block is a regional analgesia method used in lower abdominal surgeries targeting the branches of the trunkal T12-L1 nerves, located between the transversus abdominis muscle and transversalis fascia. While the TAP block covers dermatomes from T6-L1, the TFP block targets dermatomes T12-L1. A significant difference from the TAP block is that the TFP block provides effective analgesia in areas innervated by the lateral cutaneous branches emerging from the L1 dermatome that TAP block may not fully cover.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
77
A high frequency linear probe (GE Logic e R7 Ultrasonography Device, USA) device will be used while blocking in both groups.
A high frequency linear probe (GE Logic e R7 Ultrasonography Device, USA) device will be used while blocking in both groups.
Hacettepe University Hospital
Ankara, Turkey, Turkey (Türkiye)
Numeric Rating Scale
Postoperative pain assessment will be performed by a researcher at 30th minutes,1st, 2nd, 12th and 24th hours after the block, using the Numerical Rating Scale (NRS) for pain in movement. Patients will be blinded to the groups they participate in and asked to rate their pain on a scale from 0 to 10, where 0 means no pain and 10 represents the worst pain they can imagine.
Time frame: Postoperative 30th minute, 1st, 2nd, 12th and 24th hours
Tramadol Consumption
Tramadol consumption (between 0-6, 6-12, 12-24 hours) will be assessed by a patient controlled analgesia (PCA) device. Additionally, in patients receiving rescue tramadol, the amount of tramadol required will be evaluated by reviewing the patient's daily medication order records.
Time frame: Postoperative 0-6th, 6-12th, 12-24th hours
Rescue Tramadol Need
The need for rescue tramadol (Present/Absent), will be assessed by reviewing the patient's daily medication order records.
Time frame: Postoperative 0-24th hours
Adverse Reactions
Opioid associated side effects such as nausea, vomiting, constipation, pruritis, urinary retention, respiratory depression and block related complications will be assessed.
Time frame: Postoperative 24th hour
Patient Satisfaction
Patient satisfaction will be assessed by asking patients to choose one of the following options regarding their postoperative comfort: very satisfied, satisfied, neutral, dissatisfied, or very dissatisfied.
Time frame: Postoperative 24th hour
Early Mobilization
Early mobilization will be assessed based on whether the patient started to walk within the first 24 hours postoperatively.
Time frame: Postoperative 24th hour
Duration of Postoperative Hospital Stay
The duration of the postoperative hospital stay will be assessed by checking the operation day and discharge day in the hospital records.
Time frame: Postoperative 7th day
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