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Background and Aims Fast track surgery involves optimization intra-operative anesthesia management, postoperative pain and any side effects with the goal of reducing hospitalization. Multimodal analgesia engages loco-regional anesthesia and opioid sparing theory supporting fast track surgery.

Methods It is a retrospective observational cohort study conduct at ‘Santa Maria della Misericordia’ Hospital in Udine. Our primary aims was to compare the post-operative analgesia provided by TAP block versus spinal anesthesia (SA) in conjunction with general anesthesia (GA) for elective LPS hysterectomy from March to June 2023. Our secondary aims were to compare prevalence of postoperative side effects.

Results among 47 patients treated with LPS hysterectomy, 23 received SA and 24 TAP block. Population and surgical characteristics were comparable. The overall pain intensity score (NRS) is significantly reduced at 6h (0 vs 0.5, p 0.004) and 12h (0 vs 0.5, p 0.006) in the SA group compared with TAP block group. Equally SA group received less fentanyl IV intraoperatively (258 mcg vs 339 mcg, p 0.002), a lower cumulative dosage of ketorolac (150 mg vs 180 mg, p 0.044) and acetaminophen (4 g vs 5 g, p 0.001) at 48h. The incidence of PONV is higher in SA group (45.8% vs 13%, p 0.024) without impact on the length of hospitalization.

Conclusions Pts undergoing LPS hysterectomy have excellent pain control with both analgesic techniques, making them suitable in the fast-track gynecologic surgery setting. It will be necessary to review more data to reduce the incidence of PONV.