Comparison of ultrasound-guided posterior transversus abdominis plane block and lateral transversus abdominis plane block for postoperative pain management in patients undergoing cesarean section: a randomized double-blind clinical trial study

Abstract

BackgroundDue to the importance of pain control after abdominal surgery, several methods such as transversus abdominis plane (TAP) block are used to reduce the pain after surgery. TAP blocks can be performed using various ultrasound-guided approaches. Two important approaches to do this are ultrasound-guided lateral and posterior approaches. This study aimed to compare the two approaches of ultrasound-guided lateral and posterior TAP blocks to control pain after cesarean section.Materials and methodsIn this double-blind clinical trial study, 76 patients scheduled for elective cesarean section were selected and randomly divided into two groups of 38 and underwent spinal anesthesia. For pain management after the surgery, one group underwent lateral TAP block and the other group underwent posterior TAP block using 20cc of ropivacaine 0.2% on both sides. Pain intensity was evaluated based on Numerical Analog Scale (NAS) at rest and when coughing, 2, 4, 6, 12, 24 and 36 hours after surgery.ResultsThe pain at rest in the posterior group at all hours post surgery was lower than the lateral group, especially at 6, 12 and 24 hours after the surgery and the difference was statistically significant (p=0.03, p<0.004, p=0.001).ConclusionThe results of this study show that ultrasound-guided posterior TAP block compared with the lateral TAP block was more effective in pain control after cesarean section.

Evaluation of post-operative analgesic efficacy of transversus abdominis plane block in patients who underwent caesarian section under spinal anesthesia

“…They have demonstrated that posterior approach is superior to lateral approach especially in resting time [19]. In our study, lateral TAPB approach has been applied.…”

Analgesic effects and distribution of cutaneous sensory blockade of quadratus lumborum block type 2 and posterior transversus abdominis plane block: an observational comparative study

“…The results of clinical and cadaver studies suggest that the injection site of lateral TAPB may be too anterior or medial, and that a posterior approach may produce more consistent and superior analgesia with the blockade of lateral cutaneous branches of the thoracolumbar nerves [8]. Studies comparing the analgesic effects of posterior and lateral TAPB in patients undergoing a caesarean section [15] or gynecologic laparoscopic surgery [16] have shown the superior analgesic effects of posterior TAPB as compared with those of lateral TAPB.…”

The combination of transversus abdominis plane block and rectus sheath block reduced postoperative pain after splenectomy: a randomized trial

“…Nerve block with the guidance of ultrasound can increase the success, safety and quality of regional nerve blocks [6]. Ultrasound-guided rectus sheath block (RSB) and transversus abdominis plane block (TAPB) were confirmed to reduce postoperative pain and consumption of analgesics, decrease the incidence of postoperative complications and enhance recovery after the operation [7][8][9]. However, no study has investigated the analgesic efficacy of RSB or TAPB in splenectomy because neither the block range of RSB nor that of TAPB alone is sufficient for the surgical incision.Recently, some studies have applied both RSB and TAPB to reduce postoperative pain [10,11].…”