Objectives: Transversus abdominis plane (TAP) block used for management of surgical abdominal pain by
injecting local anesthetics into the plane between the internal oblique and transversus abdominis muscles. We
aimed to explore the effect of adding morphine to bupivacaine in ultrasound guided TAP-block in patients undergoing
lower abdominal cancer surgery.
Study design: Randomized, double-blind, prospective study. Clinical trial identifier: NCT02566096.
Setting: Academic medical center.
Patients: Sixty patients were enrolled in this study after ethical committee approval.
Interventions: Patients divided into 2 groups (30 each): Bupivacaine group (GB): given ultrasound guided TAPblock
20 ml 0.5% bupivacaine diluted in 20 ml saline; Morphine group (GM): given ultrasound guided TAPblock
with 20 ml 0.5% bupivacaine + 10 mg morphine sulphate diluted in 20 ml saline.
Measurements: Patientswere observed for total morphine consumption, time for first request of rescue analgesia,
sedation scores, hemodynamics and side effects for 24 h postoperatively.
Results: Morphine added to bupivacaine in TAP block compared to bupivacaine alone reduced total morphine
consumption (5.33 ± 1.28 mg) (10.70 ± 3.09 mg) respectively (p b 0.001), prolonged the time to first request
of analgesia (10.40 ± 4.96 h) (6.97 ± 3.26 h) respectively (p b 0.008), with a statistically significant decrease
in (VAS-M) in GM compared with GB at 12 h postoperatively (p b 0.002). No significant differences in hemodynamics,
respiratory rate, oxygen saturation, sedation score, and side effects except for nausea were observed
(p N 0.05).
Conclusion: Addition of morphine to bupivacaine in TAP block is effective method for pain management in patients
undergoing major abdominal cancer surgery without serious side effects