Perioperative analgesia for abdominal hysterectomies: a retrospective study

Authors

  • O.V. Filyk Danylo Halytsky Lviv National Medical University, Lviv, Ukraine, Ukraine
  • A.V. Ryzhkovskyi Yuriy Semenyuk Rivne Regional Clinical Hospital, Rivne, Ukraine, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.17.8.2021.245576

Keywords:

ERAS recommendations, hysterectomy, regional anesthesia, transversus abdominis plane block, multimodal analgesia

Abstract

Background. The effectiveness and widespread use of regional anesthesia in combination with a multimodal approach to perioperative analgesia allow them to be used for an increasing number of patients, including those undergoing surgery in gyneco­logy. The purpose of the study was to determine the effectiveness of transversus abdominis plane block as a component of multimodal analgesia compared to no regional methods of analgesia for a total abdominal hysterectomy. Materials and methods. We conducted a retrospective single-center study at the Department of Anaesthesiology and Intensive Care and the Department of Gynecology of Yuriy Semenyuk Rivne Regional Clinical Hospital (Ukraine). The study included patients aged 40–65 years with symptomatic fibroids complicated by vaginal bleedings, who required a total abdominal hysterectomy (supravaginal amputation of the uterus with ovaries). Exclusion criteria were: patient’s refusal to participate in the study at any of its stages, ASA class > IV, body mass index > 40 kg/m2, use of opioid receptor agonists/agonists-antagonists before surgery, uncontrolled arterial hypertension, heart rhythm disorders. Forty-three patients were included in data analysis. Results. It was found that the level of pain on visual analogue scale in the first group reached its maximum values at h12 and h24 stages of the study and was 4.8 [3.3; 5.8] and 5.3 [3.9; 6.4] points, respectively, while in patients of the second group at same stages of the study pain seve-rity was 2.7 [2.3; 3.5] and 2.1 [1.6; 4.1] points (p < 0.05). Significant differences were found in heart rate between the first and the second groups at h24 stage of the study (93 [87; 98] bpm in the first group and 72 [63; 79] bpm in the second, p = 0.05). There were no significant differences in mean blood pressure at all stages of the study; however, there was a tendency towards a decrease in these data throughout the study in the first group of patients. The ave-rage daily dose of nalbuphine at h24 stage has a tendency (p = 0.07) towards a decrease in the second group (40.9 ± 1.1 mg/day) compared with the first group (51.4 ± 2.9 mg/day). At h72 stage, the need in nalbuphine was significantly lower (p < 0.05) in the second group (5.8 ± 0.8 mg/day) compared to the first group (22.5 ± 4.1 mg/day). The average length of hospital stay in the first group was 6.8 ± 0.5 days, in the second one — 4.2 ± 0.2 days (p < 0.05). Conclusions. The use of bilateral transversus abdominis plane block with 0.25% bupivacaine and dexamethasone showed a tendency towards a reduction in the need for nalbuphine in the first postoperative day by 25.7 %, on the third postoperative day — by 3.9 times (p < 0.05). The length of hospital stay in the second group was decreased by 2.6 days compared to the first group (p < 0.05).

References

Mancel L., Van Loon K., Lopez A.M. Role of regional anesthesia in Enhanced Recovery After Surgery protocols. Current Opinion in Anaesthesiology. 2021 Jul. doi: 10.1097/aco.0000000000001048. PMID: 34325463.

Nelson G., Bakkum-Gamez J., Kalogera E., Glaser G., Altman A., Meyer L.A. ... et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations 2019 update. International Journal of Gynecologic Cancer. 2019. 29(4). 651-668.

Reddi D. Preventing chronic postoperative pain. Anaesthesia. 2016. 71. 64-71.

Wells N., Pasero C., McCaffery M. Improving the quality of care through pain assessment and management. Patient safety and quality: An evidence-based handbook for nurses. 2008.

Florence C., Luo F., Xu L., Zhou C. The economic burden of prescription opioid overdose, abuse and dependence in the United States, 2013. Medical care. 2016. 54(10). 901.

Meyer L.A., Lasala J., Iniesta M.D., Nick A.M., Munsell M.F., Shi Q. et al. Effect of an enhanced recovery after surgery program on opioid use and patient-reported outcomes. Obstetrics and gynecology. 2018. 132(2). 281.

Kalogera E., Bakkum-Gamez J.N., Jankowski C.J., Trabuco E., Lovely J.K., Dhanorker S. et al. Enhanced recovery in gynecologic surgery. Obstetrics and gynecology. 2013. 122(2 Part 1). 319.

Rahiri J., Tuhoe J., Svirskis D., Lightfoot N.J., Lirk P.B., Hill A.G. Systematic review of the systemic concentrations of local anaesthetic after transversus abdominis plane block and rectus sheath block. BJA: British Journal of Anaesthesia. 2017. 118(4). 517-526.

Jokela R.M., Ahonen J.V., Tallgren M.K., Marjakangas P.C. & Korttila K.T. The effective analgesic dose of dexamethasone after laparoscopic hysterectomy. Anesthesia & Analgesia. 2009. 109(2). 607-615.

De Boer Hans D., Fawcett William J., Scott Michael J. Enhanced recovery after surgery. European Journal of Anaesthesiology. 2021. 38(9). 905-907. doi: 10.1097/EJA.0000000000001509.

Published

2021-12-07

Issue

Section

Original Researches