Intrathecal hydromorphone vs. transversus abdominis plane block for upper abdominal surgery: a propensity score-matching study.

BACKGROUND

Multimodal analgesia is vital for enhanced recovery after upper-abdominal surgery. While both Intrathecal hydromorphone (ITH) and transversus abdominis plane (TAP) block are widely applied in upper-abdominal surgery, evidence comparing the two techniques remains limited. This retrospective study employs a propensity score-matching (PSM) design to evaluate the analgesic efficacy of TAP block and ITH in upper-abdominal surgeries.

METHODS

PSM analysis was performed to minimize differences in baseline characteristics. The primary outcome was defined as the incidence of moderate-to-severe pain during movement within 24 h (hr) postoperatively. The secondary outcomes included the incidence of moderate-to-severe pain at rest or during movement at different times within 72 h postoperatively, numerical rating scale score (NRS) score at rest or during movement within 72 h, complications, morphine equivalent, and indicators of postoperative rehabilitation.

RESULTS

Among the 182 patients analyzed after PSM, patients in the ITH group presented a lower incidence of moderate-to-severe pain on movement at 24 h after surgery (TAP vs. ITH, 44.0% vs. 27.5%; p = 0.02) compared to the TAP group. However, the median NRS of patients in the ITH group at rest at 48 and 72 h after surgery was higher (48 h: TAP vs. ITH, 0 vs. 1; p = 0.01) (72 h: TAP vs. ITH, 0 vs. 1; p = 0.01) than that of patients in the TAP group. Pruritus within the first 24 h after surgery occurred more frequently in the ITH group (TAP vs. ITH, 6.6% vs. 29.7%; p < 0.001). The first flatus occurred earlier in the TAP group (TAP vs. ITH, 57.0 h vs. 68.0 h; p = 0.03). The first-day morphine equivalent was significantly lower in the ITH group (TAP vs. ITH, 15.0 mg vs. 12.3 mg; p = 0.01).

CONCLUSION

This study revealed that ITH was better at reducing the incidence of moderate-to-severe pain during movement within the first day after surgery. These findings suggest that ITH could be an effective choice for upper abdominal surgery. Further validation through randomized controlled trials (RCT) is required to establish optimal pain management protocols.