Costa Fabio, Ruggiero Alessandro, Strumia Alessandro, Pascarella Giuseppe, Cuccarelli Martina, Plotti Francesco, Agrò Felice Eugenio, Carassiti Massimiliano, Cataldo Rita, Ruggiero Giovanni, Terranova Corrado, Nardone Carlo de Cicco, Montera Roberto, Angioli Roberto, Gargano Francesca, Bruno Eleonora, Sammartini Davide, Sammartini Emanuele, Martinelli Arianna, Schiavoni Lorenzo, Mattei Alessia
Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, Italy.
Department of Medicine, Research Unit of Anesthesia and Intensive Care, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy.
Saudi J Anaesth. 2025 Apr-Jun;19(2):227-234. doi: 10.4103/sja.sja_658_24. Epub 2025 Mar 25.
Total abdominal hysterectomy is a procedure associated with moderate to severe postoperative pain. Regional anesthesia techniques, such as fascial plane blocks, have shown promise in improving postoperative pain control. While continuous wound infusion is recommended for cesarean section, it is not recommended for open abdominal hysterectomy. Our aim is to compare surgically placed catheter for wound infusion with the transverse abdominis plane block.
A single-center prospective randomized controlled trial was conducted in Italy from January to July 2023. Patients undergoing elective hysterectomy were randomly assigned to receive either bilateral transverse abdominis plane block or continuous wound infusion. The primary outcome measure was the assessment of static pain in the recovery room and at 6, 12, 24, and 48 hours postoperatively using the numeric rating scale (NRS) for pain. Of the 34 patients assessed for eligibility, 32 were randomized and equally distributed between the continuous wound infusion and transverse abdominis plane block groups.
Patients receiving continuous wound infusion consistently reported lower static NRS pain scores compared to those receiving transverse abdominis plane block across all postoperative time points. The median NRS scores were significantly lower in the wound infusion group at 6, 12, 24, and 48 hours post surgery ( < 0.05). Importantly, similar significant differences were also observed between the groups for dynamic NRS scores. However, no significant differences were observed between the groups for secondary outcomes, including nausea and vomiting, and recovery of functional capacity.
Continuous wound infusion with a properly positioned catheter is noninferior to transverse abdominis plane block for postoperative pain management following total abdominal hysterectomy and may even provide superior pain control. These findings suggest continuous wound infusion as a viable alternative for effective pain management in total abdominal hysterectomy procedures.
全腹子宫切除术是一种与中度至重度术后疼痛相关的手术。区域麻醉技术，如筋膜平面阻滞，已显示出在改善术后疼痛控制方面的前景。虽然剖宫产推荐使用持续伤口灌注，但不推荐用于开放性腹式子宫切除术。我们的目的是比较手术放置的伤口灌注导管与腹横肌平面阻滞。
2023年1月至7月在意大利进行了一项单中心前瞻性随机对照试验。接受择期子宫切除术的患者被随机分配接受双侧腹横肌平面阻滞或持续伤口灌注。主要结局指标是使用数字疼痛评分量表（NRS）评估恢复室以及术后6、12、24和48小时的静态疼痛。在评估 eligibility 的34例患者中，32例被随机分组，并在持续伤口灌注组和腹横肌平面阻滞组之间平均分配。
在所有术后时间点，接受持续伤口灌注的患者持续报告的静态NRS疼痛评分低于接受腹横肌平面阻滞的患者。术后6、12、24和48小时，伤口灌注组的NRS中位数评分显著更低（<0.05）。重要的是，两组之间在动态NRS评分方面也观察到类似的显著差异。然而，两组在次要结局方面未观察到显著差异，包括恶心和呕吐以及功能能力恢复。
对于全腹子宫切除术后的疼痛管理，正确放置导管的持续伤口灌注不劣于腹横肌平面阻滞，甚至可能提供更好的疼痛控制。这些发现表明持续伤口灌注是全腹子宫切除术中有效疼痛管理的一种可行替代方法。
