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Year : 2020  |  Volume : 6  |  Issue : 3  |  Page : 27-33

A randomized controlled trial to study the effect of hyaluronidase as adjuvant in ultrasound-guided transversus abdominis plane block for postoperative analgesia in total abdominal hysterectomy

1 Department of Anaesthesiology, Rajarajeshwari Medical College and Hospital (RRMCH), Bengaluru, Karnataka, India
2 Department of Anesthesia and Critical Care, The Oxford Medical College Hospital and Research Center, Bengaluru, Karnataka, India

Correspondence Address:
Jyoti Petkar
Department of Anaesthesiology, Rajarajeshwari Medical College and Hospital, #202, Kambipura, Mysore Road, Bengaluru - 560 074, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jrap.jrap_17_20

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Background: Transversus abdominis plane (TAP) block is a regional anesthesia technique for postoperative analgesia. Since multiple nerves are to be blocked in a single prick, mucolytic enzyme hyaluronidase is being used to improve the spread of the local anesthetic. The present study was conducted to evaluate the effect of adding hyaluronidase as an adjuvant to local anesthetic in ultrasound (US)-guided TAP block. Materials and Methods: Eighty patients were randomly divided into two groups, Group B and Group BH. Group B patients received US-guided bilateral TAP block with 38 ml of 0.25% bupivacaine (heavy) and 2 ml of NS. Group BH patients received 38 ml of 0.25% bupivacaine (heavy) with 3000 IU hyaluronidase (2 ml) after completion of surgery under spinal anesthesia. Visual analog score (VAS) and heart rate were noted periodically. Time of demand of the first rescue analgesia and total analgesic consumption in 24 h were noted. Patient satisfaction survey was done at the end of 24 h. Results: Group BH patients had lower mean VAS scores at 6 and 8 h postoperatively as compared to Group B. The mean time of demand for the first rescue analgesia was longer in Group BH (351 ± 16 min) as compared to Group B (307 ± 13 min). The cumulative dose of rescue analgesic needed was more in Group B (370 ± 9 min) as compared to Group BH (343 ± 8 min). Patient satisfaction score was 3.3 ± 0.5 in Group BH and 2.3 ± 0.5 in Group B. All the differences were statistically significant. Conclusion: Addition of hyaluronidase improved quality of postoperative analgesia which can be due to the enzymatic action of hyaluronidase which hydrolyses the hyaluronic acid in the connective tissue and facilitates the spread of local anesthetic solution.

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