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

November 21, 2025 updated by: Samsun University

Comparison of the Cutaneous Sensory Block Coverage of Surgical Incisions and Clinical Effectiveness of TAP and Rectus Sheath Blocks in Total Abdominal Hysterectomies Performed With a Pfannenstiel Incision: A Prospective Observational Study

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.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Inadequate pain control after hysterectomy is associated with prolonged hospital stay, delayed recovery, decreased quality of life, and reduced patient satisfaction. Therefore, multimodal analgesia strategies that provide high analgesic efficacy with a low side-effect profile are essential in these patients during the postoperative period. Effective postoperative analgesia may also reduce the risk of developing chronic pain after hysterectomy. Although opioids are often routinely used in the postoperative period, their widespread use may lead to adverse effects such as nausea and vomiting, constipation, pruritus, urinary retention, respiratory depression, and, in the long term, an increased risk of misuse.

In our clinic, regional anesthesia techniques under ultrasound guidance are routinely administered by experienced anesthesiologists-either as single techniques or in combination-for perioperative pain management in patients undergoing hysterectomy. In addition, patient-controlled analgesia (PCA) devices are used as part of multimodal pain management.

This study was designed as an observational study. It aims to comparatively evaluate the cutaneous sensory block areas produced by bilateral Transversus Abdominis Plane (TAP) block and bilateral Rectus Sheath Block (RSB) in patients undergoing elective total abdominal hysterectomy with a Pfannenstiel incision under general anesthesia, focusing on the extent to which these regional anesthesia techniques cover the Pfannenstiel incision and their clinical effectiveness.

Among the patients who receive either of these techniques, written informed consent will be obtained, and sensory anesthesia will be evaluated at the 45th minute using the pinprick test. The sensory borders identified during the assessment will be marked on the patient's abdomen, after which an acetate sheet will be placed over the abdomen to transfer the anatomical projection of these borders. Additionally, anterior abdominal reference landmarks specific to each patient (xiphoid process, costal margin, anterior axillary line, iliac crest, inguinal ligament, and symphysis pubis) will be marked on the acetate sheet. Before the surgery begins, the Pfannenstiel incision planned by the surgeon will be drawn on the patient and transferred onto the acetate sheet.

Each acetate template will then be digitized, and the percentage of Pfannenstiel incision coverage by the cutaneous sensory block area produced by the regional anesthesia technique will be calculated using ImageJ software. Furthermore, the percentage of the anterior abdominal wall covered by the bilaterally applied regional anesthesia technique will be calculated separately for each patient.

Postoperatively, patients' pain scores will be recorded at 1, 3, 6, 12, 18, and 24 hours using the Numerical Rating Scale (NRS), both at rest and during coughing. Total analgesic consumption from the PCA device will also be documented at the same time intervals. At the end of the 24th hour, all patients will be assessed using the Quality of Recovery-15 (QoR-15) questionnaire.

Study Type

Observational

Enrollment (Estimated)

30

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

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.

Description

Inclusion Criteria:

  • 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

Exclusion Criteria:

  • 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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
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

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 Rectus Sheath Block (RSB)
Patients who received an ultrasound-guided bilateral Rectus Sheath Block during the preoperative period.
Procedure: Group Rectus Sheath Block

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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
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.
Time Frame: 45 minutes after block application
45 minutes after block application

Secondary Outcome Measures

Outcome Measure
Time Frame
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.
Time Frame: 45 minutes after block application
45 minutes after block application
Comparison of 24-hour morphine consumption between the two groups.
Time Frame: First 24 postoperative hours
First 24 postoperative hours
Comparison of Numerical Rating Scale (NRS) scores between the two groups.
Time Frame: Postoperative 1, 3, 6, 12, 18, and 24. hours
Postoperative 1, 3, 6, 12, 18, and 24. hours
Comparison of Quality of Recovery-15 (QoR-15) scores between the two groups.
Time Frame: 24 hours after surgery
24 hours after surgery

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Samsun University

Investigators

  • Study Director: Sevda Akdeniz, Samsun University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

January 1, 2026

Primary Completion (Estimated)

June 1, 2027

Study Completion (Estimated)

July 1, 2027

Study Registration Dates

First Submitted

November 21, 2025

First Submitted That Met QC Criteria

November 21, 2025

First Posted (Estimated)

December 3, 2025

Study Record Updates

Last Update Posted (Estimated)

December 3, 2025

Last Update Submitted That Met QC Criteria

November 21, 2025

Last Verified

November 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • GOKAEK 2025/20/18

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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