Effect of transversus abdominis plane block versus intravenous hydromorphone on the quality of postoperative recovery in elderly critically Ill patients in the SICU: a single-center, single-blind, randomised controlled trial.

OBJECTIVE: This study aimed to compare the effects of transversus abdominis plane block and hydromorphone on recovery quality in elderly critically ill patients after major abdominal surgery in the Surgical Intensive Care Unit, focusing on postoperative activity, analgesic efficacy, opioid-related side effects, hemodynamic stability, and hospital stay. DESIGN: A prospective, single-blind randomized controlled trial (RCT) was conducted following CONSORT guidelines. SETTING: The study took place at Jiaxing First Hospital from July 2024 to December 2025. PATIENTS: Enrolled, with 122 completing the study. Out of these 61 patients belonged to the TAP (transversus abdominis plane block) group & 61 to the control (intravenous hydromorphone) group. INTERVENTIONS: The postoperative VAS scores were assessed in patients, VAS score ≥ 4 was taken as indicative of the presence of postoperative pain. Our interventions were implemented as soon as the VAS rose to 4. Patients in the TAP group were administered ultrasound-guided transversus abdominis plane block, while those in the control group received intravenous hydromorphone. MEASUREMENTS: The primary outcome was the Quality of Recovery-40 score at 24 h postoperatively. Secondary outcomes included QoR-40 scores at 48 h, 72 h, and 7d, VAS scores, opioid consumption, complications, and hospital stay. MAIN RESULTS: The TAP group had significantly higher QoR-40 scores at 24 h (median [IQR]: 170 [167, 172] vs. 157 [153, 158], P < 0.001) and 48 h (median [IQR]162(159,165) vs 171(169,174), P < 0.001) postoperatively, along with lower VAS scores and reduced opioid consumption compared to the control group. CONCLUSION: TAP block significantly improves recovery quality and provides better analgesia than hydromorphone in elderly critically ill patients after major abdominal surgery, reducing opioid use and enhancing postoperative outcomes. It is a safe and effective alternative for pain management in the SICU. TRIAL REGISTRATION: The study was registered with the China Clinical Trial Registry (registration number: ChiCTR2400086600). Registered date: 20,240,708.