Ultrasound-guided Transversus Abdominis Plane Block After Hysterectomy

Patients undergoing abdominal hysterectomy (n=75) at Parkland Hospital will be randomized
into one of three groups to receive either ultrasound-guided bilateral TAP block with or
without NSAIDs and acetaminophen (Groups 1 and 2) or the conventional analgesic regimen
(Group 3) for postoperative pain management. The remaining aspect of perioperative care,
including the general anesthetic technique, will be standardized and similar for all
patients. The duration of the involvement in the study will be until 48 hours
postoperatively. The pre-anesthesia care unit personnel will identify patients during their
preoperative clinic visit. There will be no incentive or payment to the patients.

Patients in Group 1 and 2 will receive ultrasound-guided bilateral TAP block after surgery.
In the first 24-h postoperative period, patients in Groups 1 and 3 will receive acetaminophen
650 mg every 6 h orally, ketorolac 30 mg every 6 h, and morphine via an intravenous patient
controlled analgesia (IV-PCA) system to maintain adequate pain control. Patients in Group 2
will receive IV-PCA morphine for the first 24 hours in addition to the ultrasound-guided
bilateral block. In the 24-48 h study period, all patients will receive oral ibuprofen 800 mg
three times a day and a combination of hydrocodone/acetaminophen 5mg/500 mg 1-2 tablets every
6h, prn. The postoperative analgesia will be documented using the visual analog score (0=no
pain,10=worst pain). In addition, total opioid dose over the 48-h study period will be
documented. Postoperative nausea will be measured using a categorical scoring system (none=0,
mild=1, moderate=2, severe=3) and episodes of vomiting will be documented. Rescue antiemetics
will be given to any patient who complains of nausea or vomiting. All variables will be
assessed at 2, 6, 12, 24, and 48 hours, postoperatively by an investigator blinded to group
allocation.

Primary endpoint will be in about 24 hours after surgery morphine consumption. The secondary
endpoints will include the VAS pain score at 6, 12, 24 and 48 hours after surgery and side
effects associated with morphine use.

Inclusion Criteria:

- 18-80 years old

- Female ASA physical status 1-3 scheduled for abdominal hysterectomy

- Able to participate personally or by legal representative in informed consent in
English or Spanish

Exclusion Criteria:

- History of relevant drug allergy

- Age less than 18 or greater than 80

- Chronic opioid users who may have a tolerance to opioids

- Psychiatric disturbance

- Inability to understand the study protocol procedures

- Patient refusal