Comparison of Sensory Block Coverage and Clinical Effectiveness of TAP and Rectus Sheath Blocks in Pfannenstiel Incisions

NCT07260396 | Not Yet Recruiting

• 1 other identifier: GOKAEK 2025/20/18
• Study Type: observational
• Target: 30
• Locations: 0 countries
• Sites: N/A

Brief Summary

Hysterectomy is one of the most common major gynecologic surgeries performed for various indications, and hundreds of thousands of procedures are carried out annually, particularly in developed countries. In total abdominal hysterectomies, the Pfannenstiel incision is frequently preferred due to its advantages in terms of aesthetics, functionality, and postoperative recovery. However, this incision can cause significant postoperative pain because of the extensive cutaneous innervation of the lower abdominal wall. This pain may delay early mobilization and negatively affect patient comfort and satisfaction. As part of multimodal analgesia strategies, regional anesthesia techniques are widely used in such surgeries to reduce opioid consumption and enhance analgesic efficacy. In this context, the Transversus Abdominis Plane (TAP) block and the Rectus Sheath Block (RSB) are among the effective techniques targeting the anterior abdominal wall, and various studies have investigated their spread patterns and clinical outcomes. However, data on the extent to which these blocks provide cutaneous sensory coverage of the Pfannenstiel incision remain limited, and direct comparative mapping studies are scarce in the literature. For patients undergoing hysterectomy, regional anesthesia techniques are commonly applied perioperatively either as a single technique or in combination for pain management, with TAP and RSB being the most frequently used modalities. In addition, patient-controlled analgesia (PCA) devices are routinely employed as a component of multimodal pain management in this population. The aim of this study is to comparatively evaluate the cutaneous sensory block areas produced by the TAP and RSB regional anesthesia techniques, their rates of coverage of the Pfannenstiel incision, and their clinical effectiveness.

Conditions

Pain Management; Hysterectomy

Keywords

Regional Anesthesia; Postoperative Pain; Cutaneous Sensory Mapping

Outcome Measures

Primary Outcomes (1)

• Calculation of the coverage rates of the Pfannenstiel incision by the cutaneous sensory block areas generated by the transversus abdominis plane block and the rectus sheath block.

  45 minutes after block application

Secondary Outcomes (4)

• Calculation of the coverage rates of the anterior abdomen by the cutaneous sensory block areas generated by the transversus abdominis plane block and the rectus sheath block.

  45 minutes after block application

• Comparison of 24-hour morphine consumption between the two groups.

  First 24 postoperative hours

• Comparison of Numerical Rating Scale (NRS) scores between the two groups.

  Postoperative 1, 3, 6, 12, 18, and 24. hours

• Comparison of Quality of Recovery-15 (QoR-15) scores between the two groups.

  24 hours after surgery

Study Arms (2)

Group Transversus Abdominis Plane Block (TAPB)

Patients who received an ultrasound-guided bilateral Transversus Abdominis Plane Block during the preoperative period.

Procedure: Group Transversus Abdominis Plane Block

Group Rectus Sheath Block (RSB)

Patients who received an ultrasound-guided bilateral Rectus Sheath Block during the preoperative period.

Procedure: Group Rectus Sheath Block

Interventions

Group Rectus Sheath Block PROCEDURE

Patients will receive a bilateral rectus sheath block preoperatively under ultrasound guidance. Bilateral blocks will be performed using 0.25% bupivacaine (25 mL per side, total 50 mL). Sensory block areas will be evaluated using pinprick at predefined time points. Additionally, patients will be provided with a PCA device, and morphine consumption as well as NRS pain scores will be monitored at regular intervals.

Group Rectus Sheath Block (RSB)

Group Transversus Abdominis Plane Block PROCEDURE

Patients will receive a bilateral transversus abdominis plane block preoperatively under ultrasound guidance. Bilateral blocks will be performed using 0.25% bupivacaine (25 mL per side, total 50 mL). Sensory block areas will be evaluated using pinprick at predefined time points. Additionally, patients will be provided with a PCA device, and morphine consumption as well as NRS pain scores will be monitored at regular intervals.

Group Transversus Abdominis Plane Block (TAPB)

Eligibility Criteria

• Age: 18 Years - 70 Years
• Gender Eligibility Details: Female patients undergoing total abdominal hysterectomy with a Pfannenstiel incision will be included in the study.
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients scheduled for total abdominal hysterectomy with a Pfannenstiel incision and receiving regional anesthesia as part of their perioperative analgesia management will be included in the study.

You may qualify if:

• ASA physical status I-II-III
• Patients scheduled for elective total abdominal hysterectomy under general anesthesia and who have received either a preoperative rectus sheath block or a transversus abdominis plane block
• Aged 18-70 years
• Patients who agree to participate in the study and provide written informed consent

You may not qualify if:

• Patients who refuse to participate
• Patients who have not received any regional anesthesia technique
• ASA physical status IV
• Patients in whom unilateral or bilateral sensory spread is not observed following the bilaterally applied regional anesthesia technique
• Patients who are uncooperative or have cognitive impairment or dementia
• Patients with psychiatric disorders such as depression, mania, or schizophrenia, or those using antipsychotic medications for more than 4 weeks

Sponsors & Collaborators

• Samsun University: lead

Related Publications (3)

• Aoyama Y, Sakura S, Abe S, Wada M, Saito Y. Analgesic effects and distribution of cutaneous sensory blockade of quadratus lumborum block type 2 and posterior transversus abdominis plane block: an observational comparative study. Korean J Anesthesiol. 2020 Aug;73(4):326-333. doi: 10.4097/kja.19404. Epub 2020 Jan 31.

  PMID: 32008278 BACKGROUND

• Abuelghar WM, El-Bishry G, Emam LH. Caesarean deliveries by Pfannenstiel versus Joel-Cohen incision: A randomised controlled trial. J Turk Ger Gynecol Assoc. 2013 Dec 1;14(4):194-200. doi: 10.5152/jtgga.2013.75725. eCollection 2013.

  PMID: 24592105 BACKGROUND

• Pickett CM, Seeratan DD, Mol BWJ, Nieboer TE, Johnson N, Bonestroo T, Aarts JW. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2023 Aug 29;8(8):CD003677. doi: 10.1002/14651858.CD003677.pub6.

  PMID: 37642285 BACKGROUND

MeSH Terms

Conditions

Agnosia; Pain, Postoperative

Condition Hierarchy (Ancestors)

Perceptual Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Postoperative Complications; Pathologic Processes; Pain

Study Officials

• Sevda Akdeniz

  Samsun University

  STUDY DIRECTOR

Central Study Contacts

Busra Yilmaz, M.D.

CONTACT

905458341318; yildizbusra.md@gmail.com

Mert Yilmaz, M.D.

CONTACT

905326699555; dryilmazmert@gmail.com

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Target Duration: 1 Day
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 21, 2025
• First Posted: December 3, 2025
• Study Start: January 1, 2026
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): July 1, 2027
• Last Updated: December 3, 2025

Record last verified: 2025-11