Transversus abdominis plane infiltration and quality of recovery after laparoscopic hysterectomy: a randomized controlled trial

Obstet Gynecol. 2011 Dec;118(6):1230-1237. doi: 10.1097/AOG.0b013e318236f67f.


Objective: To examine the effect of a preoperative transversus abdominis plane infiltration on postoperative quality of recovery and analgesia in patients undergoing laparoscopic hysterectomy.

Methods: The study was a randomized, double-blinded, placebo-controlled trial. Seventy-five healthy women were randomized to receive a preoperative infiltration with 0.5% ropivacaine, 0.25% ropivacaine, or saline. Postoperative quality of recovery score (QoR-40), pain, and opioid consumption were assessed up to 24 hours after the surgical procedure. Data were analyzed using Kruskal-Wallis test. Post hoc pair-wise comparisons were made using Dunn test. P<.05 was required to reject the null hypothesis.

Results: Sixty-six patients completed the study. Patients' baseline characteristics and surgical factors were not different between groups. The ropivacaine group experienced a better quality recovery and less postoperative pain than the saline group. The median difference (99.2% confidence interval) in global recovery scores at 24 hours after surgery was 28 (QoR score 4-39, P=.001) for ropivacaine 0.5% and 28 (QoR score 10-43, P<.001) for ropivacaine 0.25% compared with saline, respectively. The 0.5% ropivacaine group also had less pain, lower opioid consumption, and faster postanesthesia care unit discharge than the saline group. Linear regression demonstrated an inverse relationship between opioid consumption and global quality of recovery at 24 hours (P<.001).

Conclusion: The transversus abdominis plane infiltration improves quality of recovery. There was an inverse linear relationship between postoperative opioid consumption and quality of recovery.

Clinical trial registration:,, NCT01074229.

Level of evidence: I.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Amides / administration & dosage*
  • Anesthesia, Local / methods*
  • Anesthetics, Local / administration & dosage*
  • Double-Blind Method
  • Female
  • Humans
  • Hysterectomy / adverse effects*
  • Laparoscopy / adverse effects
  • Middle Aged
  • Pain, Postoperative / prevention & control*
  • Prospective Studies
  • Ropivacaine


  • Amides
  • Anesthetics, Local
  • Ropivacaine

Associated data