Comparison of the effect on post-operative pain, patient satisfaction and the incidence of chronic pain by the use of either a transversus abdominis plane nerve block or a standard regime with morphine in patients undergoing surgery for total abdominal hysterectomy

INTERVENTION: Patients will be randomised to receive either a bilateral transversus abdominus plane block (TAPB) using 1 mg/kg 0.375% levobupivacaine up to a maximum of 20 ml bilaterally in addition to a standard analgesia regime of patient contolled morphine (1 mg/ml maximum 12 ml/hr) and intravenous paracetamol (1 g 6‐hourly). Patients randomised to receive a standard analgesia regime only will have 1 ml of 0.375% levobupivacaine injected into the area where the TAPB would normally be performed in order to maintain the double blind nature of the trial. Added 09/08/2011: Trial closed early due to low recruitment secondary to change in surgical technique ‐ 30 patients recruited in total. CONDITION: Total abdominal hysterectomy ; Surgery ; Hysterectomy PRIMARY OUTCOME: The reduction in visual analogue scores (VAS) in the post‐operative period for patients undergoing total abdominal hysterectomy. SECONDARY OUTCOME: 1. Usage of morphine sulphate in the post‐operative period; 2. Incidence of nausea and/or vomiting within the first 48 hours after surgery; 3. Measurement of oxygen saturations without supplemental oxygen in both groups in the post‐operative period; 4. Incidence of complications associated with the analgesia techniques in both groups; 5. Patient satisfaction with analgesia technique; 6. Incidence of chronic pelvic pain at 3 months INCLUSION CRITERIA: 1. American Society of Anaesthesiologists (ASA) class I ‐ III 2. Patients able to give written informed consent 3. Patients requiring total abdominal hysterectomy 4. Female patients aged 18 years and over