• Samina Ismail, Aliya Ahmed, Muhammad Q Hoda, Samie Asghar, Aysha Habib, and Aliya Aziz.
• From the Department of Anaesthesiology (SI, AA, MQH, SA), Department of Pathology and Laboratory Medicine (AH) and Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan (AA).
• Eur J Anaesthesiol. 2021 Jul 1; 38 (7): 768776768-776.

BackgroundThe hormonal response to surgical trauma can have detrimental effects on patients. Transversus abdominis plane (TAP) block, which can improve analgesia after total abdominal hysterectomy (TAH) might attenuate the peri-operative stress response.ObjectiveTo evaluate the ability of the TAP block to reduce stress response, opioid consumption and pain following TAH and multimodal analgesia.DesignRandomised, placebo-controlled double-blind study.SettingThe current study was conducted at a university hospital from July 2016 to September 2017.PatientsFifty patients scheduled for TAH were included. Anaesthesia and postoperative analgesia were standardised.InterventionAfter induction of anaesthesia, patients were allocated into two groups: ultrasound-guided bilateral mid-axillary TAP block with 20 ml of bupivacaine 0.25% (Group T) or 0.9% saline (Group C).Main Outcome MeasuresLevels of free serum cortisol, metanephrine and normetanephrine at 60 min and 6, 12 and 24 h after surgical incision. Pain scores and opioid consumption during the first 24 h after surgery.ResultsThere was no statistically significant difference between the median [IQR] peri-operative levels of stress hormones and pain scores between groups. Compared with baseline value 9.90 [4.2 to 23.1], free serum median cortisol levels were significantly high at 6 h in Group T, 23.6 [10.1 to 42.9] P = 0.015 and Group C 23.6 [9.9 to 46.3] P = 0.014. Only Group C showed significant elevation from the baseline median levels of plasma metanephrine at 60 min, 52.8 [33.4 to 193.2] P = 0.001, 6 h, 92.70 [2.4 to 202.6] P = 0.005 and normetanephrine at 60 min 83.44 [28.98 to 114.86] P = 0.004, 6 h 78.62 [36.6 to 162.31] P = 0.0005 and 24 h 80.96 [8.6 to 110.5] P = 0.025. Mean ± SD opioid consumption was similar in both groups: 39.60 ± 14.87 in Group T vs. 43.68 ± 14.93 in Group C (P = 0.338).ConclusionMid-axillary TAP block does not improve stress response and analgesia in patients undergoing TAH receiving multimodal analgesia.Trail RegistrationClinicalTrial.gov identifier: NCT03443271.Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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