Comparison of local anesthetic applications to lumbar epidural, transversus abdominis plane block and surgical incision in postoperative pain treatment in major abdominal surgeries

Objective: The aim of our study was to compare the effects of lumbar epidural injection, transversus abdominis plane block and local anesthesia in the surgical incision on patient-controlled morphine consumption, postoperative pain score, first analgesia demand time, patient satisfaction scores and side effects for the treatment of postoperative pain in major abdominal surgeries. Materials and Methods: Following the decision of the Ethics Committee of Çukurova University Faculty of Medicine and the written informed consent of the patients, 81 patients with ASA scores of 1 and 2, ages 18-69 and major gynecological abdominal surgery were included in our study, which was planned as a prospective, randomized and double-blind study. Patients were randomized and double-blinded into 3 groups as lumbar epidural block (Group E), TAP block (Group T), and local anesthesia application to the surgical incision (Group L). Patients who underwent general anesthesia were given an injection of 20 ml bupivacaine of 0.125% from the epidural catheter inserted in the preoperative period and with a test dose approximately 20 minutes before extubation to Group E, 10 ml of 0.125% bupivacaine on both sides in the ultrasound guideline to Group T, TAP block with a total of 20 ml, and Group L received 20 ml of bupivacaine at the surgical incision site approximately 20 minutes before extubation. All patients were allowed to use patient-controlled morphine. Demographic data of the patients, hemodynamic data at postoperative 1, 2, 6, 12, 24, 36 and 48th hours, VAS values at rest and mobilization, PCA morphine consumption, additional (urgent) analgesic (meperidine) use, patient satisfaction scores and side effects were recorded. Results: The demographic and hemodynamic data of the groups were similar. VAS values at rest, in the 1st, 2nd, 6th, 12th hours and at mobilization, in the 1st 2st, 6th, 12th and 24th hours were found to be statistically significantly lower in Group E than in Group T and L (p<0.001). VAS scores at rest in the 6th hours were statistically significantly lower in group T than in Group L. Patient-controlled morphine consumption was found to be statistically significantly lower in Group E than in Groups T and L at 2.6.12.24.36. and 48 hours (p<0.05). In Group T, compared to Group L; patient-controlled morphine consumption at only hours 6 and 12 was statistically significantly lower. The time of initial analgesia request in Group L was statistically significantly shorter than that of Group E and Group T, and in Group T it was significantly shorter than that of Group E. Conclusion: It was concluded that lumbar epidural anesthesia for the treatment of postoperative pain in major lower abdominal gynecological surgeries caused less patient-controlled morphine consumption, longer initial analgesia demand time and higher patient satisfaction scores without causing an increase in side effects compared to transversus abdominis plane block and local anesthesia infiltrations to the surgical incision area.