Archives of Gynecology and Obstetrics

, Volume 288, Issue 1, pp 105–111

Ultrasound-guided Transversus abdominal plane block with multimodal analgesia for pain management after total abdominal hysterectomy

  • Irina Gasanova
  • Erica Grant
  • Megan Way
  • Eric B. Rosero
  • Girish P. Joshi
General Gynecology



Transversus abdominis plane (TAP) block has been shown to provide pain relief after abdominal procedures. However, TAP block combined with multimodal analgesia technique have not been assessed in a randomized controlled trial. This randomized, controlled, observer-blinded study was designed to evaluate the analgesic efficacy of bilateral ultrasound-guided TAP blocks with or without acetaminophen and non-steroidal anti-inflammatory drug (NSAID) combination.


Patients undergoing total abdominal hysterectomy were randomized to one of three groups. Group 1 (n = 25) received a TAP block and ketorolac 30 mg, IV at the end of surgery and then ketorolac plus paracetamol 650 mg, orally, every 6 h for 24 h. Group 2 (n = 24) received only TAP block at the end of surgery. Group 3 (n = 25) received ketorolac 30 mg, IV at the end of surgery and then ketorolac plus paracetamol 650 mg, orally, every 6 h for 24 h. All patients received IV-PCA morphine for 24-h, postoperatively. All patients received a standardized general anaesthetic technique and dexamethasone 4 mg and ondansetron 4 mg, IV for antiemetic prophylaxis.


There were no statistically significant differences in pain at rest between the groups. However, the pain on coughing (dynamic pain) in Group 1 was significantly less variable, compared with the other two groups (P = 0.012). Opioid consumption and occurrences of nausea, vomiting, and rescue antiemetic were similar in three the groups.


The combination of TAP block and acetaminophen and NSAID provided less variability in dynamic pain compared with either treatment alone.


Total abdominal hysterectomy Multimodal analgesia Transversus abdominis plane block 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Irina Gasanova
    • 1
  • Erica Grant
    • 1
  • Megan Way
    • 1
  • Eric B. Rosero
    • 1
  • Girish P. Joshi
    • 1
  1. 1.Department of Anesthesiology and Pain ManagementUniversity of Texas Southwestern Medical CenterDallasUSA

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