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Abstract
Background and Aims Abdominal hysterectomy (AH) is associated with significant pain. Adequate pain control is essential for improving postoperative outcomes. Although PROSPECT guidelines, dating back to 2006, do not recommend continuous wound infusion (CWI) for AH, the references cited in the guideline used the subcutaneous space as a site for infusion. However, the recent PROSPECT guideline for cesarean section considers CWI effective for analgesia. Given the similarity in incision and surgical site, we conducted a randomized controlled trial to compare deep CWI with transversus abdominis plane (TAP) block, the most commonly used regional anesthesia technique for abdominal surgeries, for AH.
Methods After ethical committee approval (71.22) (NCT05686382), we started to enroll patients scheduled for AH with Pfannenstiel incision. The intervention group received 48 hours of continuous ropivacaine 0.2% infusion through a prefilled fixed rate pump (Ropivacaine ReadyfusOR – BioQ Pharma) via a multi-holed catheter placed along the incision line between transversalis fascia and parietal peritoneum. The control group received a bilateral TAP block with ropivacaine 0.5% 20 ml. We recorded data on pain scores at rest and in motion, opioid consumption, and postoperative side effects.
Results Preliminary data from the first ten cases showed differences in pain scores (NRS) in favor of the CWI group as shown in table 1. No differences emerged for other outcomes so far.
Mean NRS in the two groups; green highlighted differences (>2 points) are deemed clinically significant
Peel away introducer placed below the rectus muscles for a deep catheter placement
Prefilled pump preparation for infusion
Conclusions Preliminary data showed CWI as not-inferior to the TAP block for AH for postoperative pain control. We believe that final data will confirm this result.