Transversus Abdominis Plane Block, Intrathecal Morphine, or Their Combination for Postoperative Analgesia Following Total Abdominal Hysterectomy. A Comparative Study.

Background:Effective postoperative pain control after total abdominal hysterectomy(TAH)is essential for rapid recovery and reduced morbidity.Multimodal analgesia and regional anesthesia techniques are widely used to enhance analgesic efficacy while reducing opioid consumption. Aim:To evaluate the effectiveness of intrathecal morphine and transversus abdominis plane(TAP)block either alone or combined using low dose morphine as components of multimodal postoperative pain management for total abdominal hysterectomy. Methods:In this prospective, randomized study 75patients scheduled for elective TAH were randomized into three groups to receive either TAP block,intrathecal morphine,or both using low dose intrathecal morphine.Primary outcome was time to first analgesic request. Secondary outcomes included pain scores(NRS 0-10),total analgesic consumption,incidence of nausea/vomiting, pruritus,respiratory depression or hemodynamic compromise. Results:The time to first analgesic request was significantly shorter in Group 1(8.44±2.77 h)compared to Group 2(21.84±1.91 h)and Group 3(23.52±1.05 h)(P