KUMJ | VOL. 15 | NO. 2 | ISSUE 58 | APRIL-JUNE 2017
Postoperative Analgesic Effect of Morphine Added to Bupivacaine for Transversus Abdominis Plane (TAP) Block in Appendectomy
Ghimire A, Bhattarai B, Prasad JN, Subedi A, Thapa P, Limbu PM, Adhikari S
Abstract: Background
Transversus abdominis plane (TAP) block with local anaesthetics produces effective
pain relief following lower abdominal surgeries. Although opioids have been found
to have effects through peripheral receptors also, reports on their effect when used
as additive to local anaesthetics for TAP block are lacking.
Objective
To assess the analgesic effect of peripherally administered morphine with bupivacaine
for ipsilateral TAP block in patients undergoing emergency appendectomy under
general anaesthesia.
Method
Sixty patients undergoing appendectomy were randomized to undergo ipsilateral TAP
with 20 ml of 0.5% bupivacaine plus 2 ml of NS (total 22 ml) and 2 ml of intravenous
(IV) saline (Group TB) or with 20ml of 0.5% bupivacaine plus 2 mg (2 ml) of morphine
(total 22 ml) and 2 ml of NS IV (Group TBM) or with 20 ml of 0.5% bupivacaine plus
2 ml of NS (total 22 ml) and 2 mg (2 ml) IV morphine (Group TB-IVM). Pain severity
was measured using Visual Analogue Scale (VAS) preoperatively (Baseline) and at 30
min, 6h, 12 h and 24 h postoperatively. Inj. tramadol 50 mg IV was used as rescue
analgesic when postoperative VAS was 4 or more. The duration of analgesia (time
to first analgesic) and the postoperative 24 h tramadol requirement was recorded.
Result
The mean duration of analgesia in Group TBM was significantly longer (801.50 ± 74.92
min, p=0.002) than in Group TB (720.00 ± 42.17 min) and Group TB-IVM (712.70 ±
40.94 min). The mean postoperative 24 h tramadol requirement was also less in
Group TBM (69.23 ± 25.31mg) than in Groups TB (100.00 ± 38.34 mg) and TB-IVM
(95.00 ± 39.40 mg) but did not reach the level of statistical significance (p=0.057).
Significantly less ondansetron was required in Group TBM (3.80 ± 2.04 mg) than in
Group TB (6.80 ± 2.93 mg) and TB-IVM (6.00 ± 2.75 mg) (p=0.002).
Conclusion
Morphine added to bupivacaine effectively prolongs the analgesic duration of TAP
block in appendectomy.
Keyword : Morphine, postoperative analgesia, transversus abdominis plane block, USG guided
