Analgesic efficacy of transverse abdominal plane block after elective cesarean delivery – Bupivacaine with fentanyl versus bupivacaine alone: A randomized, double-blind controlled clinical trial

Abstract

Background:The analgesic benefit of transversus abdominis plane (TAP) blocks for cesarean delivery remains controversial. In our study, we compared the analgesic efficacy of TAP block using local anesthetic bupivacaine and adjunct fentanyl with bupivacaine alone in patients undergoing elective cesarean section.Methods:Our study was a randomized, double-blind, controlled clinical trial where sixty patients undergoing elective cesarean delivery under subarachanoid block (2 ml of 0.5% bupivacaine) were randomized into two groups, A and B. At the end of the surgical procedure, bilateral TAP block was performed guided by the ultrasound. Group A received 38 ml of 0.25% bupivacaine and 2 ml of 50 μg of fentanyl, whereas Group B received 38 ml of 0.25% bupivacaine + 2 ml of normal saline. The total volume was divided equally and administered bilaterally. Each patient was assessed for 24 h after TAP block, for time to rescue analgesia, pain using visual analog scale (VAS) score at rest and on movement, hemodynamic parameters (heart rate and blood pressure), nausea, vomiting, and sedation. Diclofenac 75 mg was given as rescue analgesia when the patient complained of pain or when VAS score >4.Results:Prolonged postoperative analgesia was noticed with both the groups, with a mean time to rescue analgesia of approximately 6.5 h. There was no significant difference in time to rescue analgesia (6.49 ± 0.477 vs. 6.5 ± 0.480) when both the groups were compared among themselves. The pain scores among the two groups when compared did not show any added benefit. Incidence of nausea, vomiting, and sedation when compared between both the groups showed no difference.Conclusion:The TAP block as a part of a multimodal analgesic regimen definitely has a role in providing superior analgesia in the postoperative period. However, adjunct fentanyl to local anesthetic bupivacaine was found to have no added advantage when quality and duration of analgesia was compared.

Comparative analysis of duration of postoperative analgesia between levobupivacaine and levobupivacaine with clonidine after ultrasound-guided transversus abdominis plane block in patients undergoing lower segment cesarean section

“…However, adjunct fentanyl to local anesthetic bupivacaine was found to have no added advantage when quality and duration of analgesia were compared. [ 18 ]…”

Anesthetic management for cesarean section and tubal ligation in a patient with Marfan syndrome, multiple sclerosis, and multiple postdural puncture headaches

“…We used bupivacaine, which is commonly employed for these blocks. 12,13 Perhaps performing the TAP block preoperatively would have allowed more time for the block to set up, producing a better pain score.…”

Analgesic efficacy of ultrasound guided transversus abdominis plane (Tap) block after caesarean delivery- A prospective randomized controlled trial

“…Caesarean delivery is a major surgical procedure after which substantial post-operative pain [moderate to severe] and discomfort can be anticipated and failure to treat it adequately may affect maternal-infant bonding, breastfeeding, 1,2 as well as may expose the mother to risk of thromboembolism 3 as a result of immobility. The provision of effective post-operative analgesia is of key importance to facilitate early ambulation, infant care and prevention of post-operative morbidity.…”