EFFICACY OF ULTRASOUND GUIDED BILATERAL TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING ELLECTIVE CAESAREAN SECTION UNDER SPINAL ANAESTHESIA
Usma Jabeen*, Suhail Banday and Heena Chowdhary
Background: Pain after cesarean section has two components, due to skin incision (somatic pain) and uterine contraction (visceral pain). Inadequately treated postoperative pain may affect mother-child bonding, care of newborn baby, and breastfeeding and may increases risk of postoperative complications such as venous thromboembolism, associated respiratory complications and prolong hospital stay. Transversus abdominis plane (TAP) block is a fascial plane block (located between the internal oblique and transverse abdominis muscles), thus providing post‑operative analgesia in infra‑umbilical surgery by blocking neural afferents between T6 and L1. In this study, we evaluated postoperative analgesic efficacy of USG guided TAP block with bupivacaine for 24 h after elective caesarean section through a Pfannenstiel incision under spinal anaesthesia. Methods: 80 parturients scheduled to undergoing elective cesarean section under spinal anesthesia with bupivacaine were randomly allocated into two groups. At the end of surgery they receive either ultrasound-guided bilateral TAP block (group B, n=40 patients) with 20 ml of 0.25% bupivacaine or no TAP block (group C, n=40 patients), in addition to standard analgesia with intravenous 1gm paracetamol TID and 75 mg diclofenac TID. Each patient was assessed at 0, 1, 2, 4, 6, 12, and 24 h after surgery by an independent observer for pain by visual analogue score (VAS) and requirement of rescue analgesia, time of 1st demand for tramadol, total consumption of tramadol, satisfaction with pain management and side effects. Results: Total tramadol consumption was reduced by 60% in patients received bilateral TAP block with bupivacaine compared to patients given no block during 24 h after surgery (P < 0.001). Post‑operative VAS was lower in study group 9Group B) both on rest and activity at each time point for 24 h (P < 0.001), time of first rescue analgesia was significantly prolonged, better patient’s satisfaction score, and side effects like nausea and vomiting were less in study group compared to control group. Conclusion: US guided bilateral TAP block reduced tramadol consumption, improved postoperative analgesia, and patient’s satisfaction regarding analgesia after caesarean section in the first 24 h.
Keywords: Ultrasound guided (USG), transversus abdominis plane (TAP) block, internal oblique muscle (IOM), transversus abdominis muscle (TAM), Bupivacaine, postoperative analgesia, visual analogue scale (VAS), cesarean section C/S.
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