A prospective study of efficacy of ultrasound guided transversus abdominis plane block for postcesarean analgesia
Keywords:Bupivacaine, Postcesarean analgesia, Tap, Transversus abdominis plane block
Background: The ultrasound guided transversus abdominis plane (TAP) block which provides effective analgesia after lower abdominal surgeries including caesarean section. It is a simple and reliable technique. In this prospective, randomized double-blind study, we determined the efficacy of TAP block using 0.25% Bupivacaine and 0.9N Saline with respect to VAS for pain, postoperative Tramadol consumption and post-operative ondansetron usage.
Methods: This study was conducted on 100 adult patients of ASA physical status I and II in the age group of 18 to 40 years undergoing elective lower segment cesarean section under spinal anaesthesia. Study group received TAP block with 0.25% Bupivacaine and control group received 10 ml of 0.9N saline on each side. Patients were analyzed for postoperative pain by pain score (at rest, on movement, on cough) using VAS was recorded at 0, ½, 1, 2, 4, 6, 12 and 24 hours postoperatively. Need for rescue analgesia was assessed by time to first dose of Tramadol requirement and total dose of Tramadol over 24 hours of postoperative period. Ondansetron (4 mg i.v.) was administered whenever nausea score was more than 2 or the patient vomited. All the data was noted using uniform performs.
Results: Patients received TAP block with 0.25% Bupivacaine had better pain scores at first hour of postoperative period during rest, cough and movement which was statistically significant (p<0.0010) in comparison to group B. There was a statistically significant difference (p <0.001) in the requirement of total dose of Tramadol as a rescue analgesia in patients who received transversus abdominis block with 0.25% Bupivacaine (138.77 mg) in comparison with other group(240 mg).The mean time to first request for Tramadol was significantly longer in group A (5.8 hrs) in comparison to group B (1.93 hrs) with p value <0.001. Patients received TAP block with 0.9N saline needed more dose of Ondansetron, however, the difference was not statistically significant (p >0.001).
Conclusions: TAP block using ultrasound provides substantial reduction in Tramadol consumption, time to first dose of rescue tramadol when compared with control group. This study reinforces the recommendation for TAP as a part of multimodal post-operative analgesic regimen.
Carr DB, Goudas LC. Acute pain. Lancet. 1999;353:2051-8.
Breivik H. Postoperative pain management: why is it difficult to show that it improves outcome? Eur J Anaesthesiol. 1998;15:748-51.
Practice guidelines for acute pain management in the perioperative setting: a report by the American Society of Anesthesiologists Task Force on Pain Management, Acute Pain Section. Anesthesiology. 1995;82:1071-81.
Twersky R, Fishman D, Homel P. What happens after discharge? Return hospital visits after ambulatory surgery. Anesth Analg. 1997;84:319-24.
Aveline C, Le Hetet H, Le Roux A. Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair. Br J Anaesth. 2011;106:380-6.
Rafi AN. Abdominal field block: A new approach via the lumbar triangle. Anaesthsia. 2001;56:1003-5.
Netter FH. Abdomen posterolateral abdominal wall. In: Netter FH, ed. Atlas of human anatomy summit. New Jersey, USA: The Ciba-Geigy Corporation. 1989:230-40.
McDonnell JG, O’Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg. 2007;104:193-7.
McDonnell J, Curley G, Carney J, Benton A, Costello J, Maharaj C, et al. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: A Randomized Controlled Trial. Anesthesia and Analgesia. 2008;106:186-91.
Charlton S, Cyna AM, Middleton P, Griffiths JD. Perioperative transversus abdominis plane (TAP) blocks for analgesia after abdominal surgery. Cochrane Database Syst Rev. 2010;12:CD007705.
Tomoaki H, Yoshihisa K. Modified ASA physical status (7 grades) may be more practical in recent use for preoperative risk assessment. Internet J Anesthesiol. 2007;15.
McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988;18:1007-19.
Hirose M, Hara Y, Hosokawa T, Tanaka Y. The effect of postoperative analgesia with continuous epidural bupivacaine after cesarean section on the amount of breast feeding and infant weight gain. Anesthesia and Analgesia. 1996; 82(6):1166-1169.
Henderson JJ, Dickinson JE, Evans SF, McDonald SJ, Paech MJ. Impact of intrapartum epidural analgesia on breast-feeding duration. Aust NZJ Obstet Gynaecol. 2003;43:372.
Belavy D, Cowlishaw PJ, Howes M, Phillips F. Ultrasound-guided transversus abdominis plane block for analgesia after Caesarean delivery. Br J Anaesth. 2009;103:726-30.
Baaj JM, Alsatli RA, Majaj HA, Babay ZA, Thallaj AK. Efficacy of ultrasound-guided transverses abdominis plane (TAP) block for postcesarean section delivery analgesia - A double-blind, placebo controlled, randomized study. Middle East J Anaesthesiol. 2010;20:821-6.