Ultrasound Blocks for the Anterior Abdominal Wall

9. Obstetric and Gynecologic Surgery | 77
opioids is another risk. Side effects reduce overall patient
satisfaction, and techniques that reduce opioid requirements
may be of benefit.
Some authors state that IIB or TAPB may offer no benefit on
pain control compared to neuraxial morphine (Costello 2009,
Kanazi 2010, McMorrow 2011). The addition of morphine to the
local anesthetic is easier to perform, is less time-consuming and
does not require extra equipment or skills to be performed
(Kanazi 2010). However, subarachnoid morphine 0.1-0.2 mg
provided better analgesia but with more adverse effects (Costello
2009, Kanazi 2010, Puddy 2010). In a study, patients receiving
both subarachnoid anesthesia with 0,1 mg morphine and a TAPB
had a higher incidence of pruritus and anti-emetic use. Less pain
on movement and later postoperative morphine request were
shown by patients receiving subarachnoid morphine compared
to saline (McMorrow 2011).
Gynecologic Surgery
Few trials have evaluated abdominal blocks for gynecologic
surgery. Bilateral IIB for total abdominal hysterectomy or
prolapse repair through a Pfannenstiel incision under general
anesthesia has shown to reduce prevalently dynamic pain and
morphine need. In a study the reduction of morphine was 51%
(21 +/- 9 mg vs. 41 +/- 24 mg) during the first two postoperative
days with a more rapid control of early postoperative pain
(Oriola 2007).
Bilateral TAPB in total abdominal hysterectomy significantly
reduced morphine requirements at all time points for 48 hours.
A longer time to first morphine request and reduced
postoperative pain scores at rest and on movement were shown
compared to the placebo (Carney 2008 (2)).
The reduction in pain scores is often not significant,
suggesting the existence of additional pain from deep pelvic
dissection and suturing of the vaginal vault during hysterectomy