Intrathecal Morphine Versus Four-Quadrant Transversus Abdominis Plane Blocks in Gynecologic Cancer Surgery: A Single-Center Retrospective Study

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Abstract
Objectives: An effective and harmless analgesic method for postoperative pain management in abdominal surgery remains undefined. Although intrathecal morphine(ITM) and four-quadrant transversus abdominis plane blocks(four-quadrant TAPB) are frequently preferred for postoperative analgesia, their effectiveness is still controversial. The aim of this study was to evaluate the efficacy of 4 quadrant TAPB with ITM in postoperative analgesia in gynaecological cancer surgeries. Methods: In this study, we retrospectively compared the effectiveness of intrathecal morphine and four-quadrant transversus abdominis plane blocks for postoperative analgesia in patients undergoing clossed or open major gynecologic cancer surgery. Results: We retrospectively evaluated a total of 65 patients operated on for gynecologic cancer. In terms of perioperative analgesic methods, 46% of these patients received ITM and 54% received four-quadrant TAPB. Demographic data, American Society of Anaesthesiology (ASA) clinical classification, operation time and length of hospital stay were similar. Postoperative 1- and 24-hour numeric rating scale (NRS) scores and opioid consumption were lower in the ITM group (p< 0.05). When the patient population was evaluated laparotomically and laparoscopically, it was found that the postoperative 1- and 24-hour NRS values, postoperative 24-hour opioid consumption levels and opioid demand levels in laparoscopic cases were lower in the ITM group (p< 0.05). Postoperative adverse effects and complications were similar in both groups. Conclusion: It was found that in gynecologic cancer surgery, intrathecal morphine was more effective in postoperative pain management and reduced the need for postoperative opioids compared to four-quadrant transversus abdominis plane blocks.

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