Comparison of postoperative analgesic efficacy of transversus abdominis plane (TAP) block and transversalis fascia plane (TFP) block in patients undergoing elective total abdominal hysterectomy

Total abdominal hysterectomy is one of the most common surgical procedures performed in women, causing significant pain and discomfort in the postoperative period. TAP block, commonly used for postoperative analgesia in abdominal surgeries including abdominal hysterectomy, has been widely applied. A relatively new field block called TFP block, providing sensory innervation of the ilioinguinal and iliohypogastric nerves, covering the T12-L1 dermatome, has been introduced for patients undergoing surgeries like iliac bone graft, cesarean section, and inguinal hernia. In this study, our aim is to evaluate the usability of TFP block as an alternative to TAP block in routine practice for patients undergoing abdominal hysterectomy, in terms of analgesic effectiveness, patient satisfaction, mobilization and length of hospital stay. After obtaining ethical approval and consent from participants who underwent general anesthesia for total abdominal hysterectomy due to benign uterine neoplasms, a total of 74 patients were administered bilateral TAP and TFP blocks for postoperative analgesia, along with IV tramadol PCA device for pain management. Additionally, patients received 1g IV paracetamol and 4 mg IV ondansetron as part of the multimodal analgesia approach. Data collected for the study were from preoperative anesthesia assessment forms and postoperative patient follow-up. Demographic characteristics of patients in TAP and TFP block groups were similar. Looking at the NRS scores of patients during the postoperative period, pain scores were similar for both groups at 30 minutes, 1 hour, and 2 hours. However, TFP block group had statistically significantly lower pain scores at 12 and 24 hours. Comparing opioid consumption, PCA opioid usage was similar between both groups at 0-6 and 6-12 hours. Yet, TFP block group had significantly lower opioid consumption during the 12-24 hour interval. In terms of total opioid consumption over 24 hours, rescue analgesic requirements, and consumption, there was no statistically iv significant difference between the two groups. Side effects related to opioid consumption, specifically nausea and vomiting, were observed in both groups, but no block-related complications were reported. Patient satisfaction and length of hospital stay did not show statistically significant differences between the two block types. The study found high overall patient satisfaction and an average hospital stay of 1.8 ± 0.78 days. Analyzing the relationship between total tramadol consumption and patient satisfaction, as well as hospital stay, revealed that patients with lower tramadol consumption had significantly higher satisfaction and shorter hospital stays. In conclusion, TFP block, like TAP block, can be applied as part of multimodal analgesia for patients undergoing abdominal hysterectomy. TFP block was found to be at least as effective as TAP block for postoperative analgesia and provided better pain control in certain aspects. Keywords: Transversalis Fascia Plane block, Transversus Abdominis Plane block, total abdominal hysterectomy, postoperative analgesia, ultrasound, opioid, ERAS protocol.