The Effect of Ultrasound-guided TAPB on Pain Management after Total Abdominal Hysterectomy

BACKGROUND: Incisional pain is particularly troublesome after hysterectomy. A method called transversus abdominis plane block (TAPB) has shown promise in managing postoperative pain. In this study, we evaluated the analgesic efficacy of ultrasound-guided TAPB after hysterectomy at different time points and at each time point separately for 48 hours. METHODS: Forty-two patients (ASA I, II) who were electively chosen to undergo total abdominal hysterectomy were divided into 2 groups, control (group C) and intervention (group I). Twenty-one patients underwent TAPB (group I) and 21 patients received only the standard treatment with a fentanyl pump (group C). Both groups received standard general anesthesia. For patients in group I, following the surgery and before emergence from anesthesia, 0.5 mg/kg of ropivacaine 0.2% (about 20 cc) was injected bilaterally between the internal oblique and transverse abdominis muscles using sonography. Pain scores using the Visual Analogue Scale (VAS) and drug consumption were measured at 2, 6, 12, 24, and 48 hours after TAPB. RESULTS: There were no significant differences in demographics between the two groups. VAS scores appeared to be lower in group I, although there was no interaction with time when we compared mean VAS measurements at different time points between group I and group C (P > 0.05). The amount of fentanyl flow was consistently higher in group C, but when we compared the two groups at each time point separately, the observed difference was not statistically significant (P < 0.053). The incidence of vomiting was 10% in group I and 28% in group C. There were no complaints of itching, and sedation score was 0 to 3. There were no complications. CONCLUSIONS: This study showed that TAPB did not result in a statistically significant decrease in VAS scores at different time points. TAPB did lead to decreased fentanyl flow, but when we compared the two groups at each time point separately, the observed difference was not statistically significant.

Incidence of Breast cancer in breast sample pathology reports in Iran [Kermanshah] 2001-2004

Despite the high incidence of breast cancer and it's high mortality and morbidity in the west, there was not an accurate survey on the types of breast pathologies in breast sample reports. In a descriptive survey of breast sample reports 2001-2004 in IRAN [Kermanshah], from 48,742 histo-pathologic reports, 904 reports were related to breast. The data from breast pathology reports were analyzed with descriptive statistics. The most common age for patients with breast pathologies was 21-40 [52.1%]. In 89.5% the Dimples were related to women and 10.5% to men. Fibroadenoma was the most common disorder reported in breast samples under 20 years old [52.3%], fibrocystic disease among 20-40 and breast malignancy among 41-60 [59.3%] Over age 60 also breast malignancy [41.9%] was the most common diagnosis, 1.02% of breast cancers were in men and other cases were in women. In 23.9% of women samples the diagnosis was breast malignancy, 34.35% of cases with malignancy were under age 40. Mean age of breast cancer was 45 +/- 9. The most prevalant pathology in malignancies was invasive ductal carcinoma [52.7%]. The mean age of breast cancer in our survey is lower than western reports and breast cancer under age 40 is more common. In future studies the cause must be evaluated .Malignancy in breast samples was 23.9%, That coordinates with western reports