Efficacy of Trans-abdominis Plane Block for Post Cesarean Delivery Analgesia in Low-income Countries: a Phase Three Feasibility Study.

Abstract

Background: Optimal pain control in a parturient woman undergoing caesarean section is essential for preventing complications such as venous thrombo-embolism and improving maternal satisfaction, early functional recovery, mother-baby bond and breastfeeding. Intentional pain assessment and adequate management to acceptable pain severity using multimodal methods can be achieved in low-middle income countries (LMICs).Aim: Is to assess the efficacy of transversus abdominis plane (TAP) block and satisfaction post cesarean delivery analgesia at Kilimanjaro Christian Medical Centre in Low-Income countries. Methods: The study population consisted of 72 participants who met criteria posted for elective and emergency caesarean section. They were blindly assigned into two groups: group A was the interventional group which received TAP block and standard pain management according to local protocols and consisted of 41 participants and group B was the control group which received standard pain management without TAP block and consisted of 31 participants. In Group A 30ml of 0.25% bupivacaine single shot was deposited in the TAP plane bilaterally for postoperative analgesia. Participants were randomized using a parallel method. Their demographics were recorded before surgery and visual analogue scale was used to assess postoperative pain at rest and on movement, and maternal satisfaction at 0hrs, 6hrs, 12hrs and 24hrs.Results: Total of 72 patients were analyzed using NRS with pain score at 0hr, 6hr and 12hr was significantly low by about 50% in Intervened group as compared to control group with (p-value (2 tail) of < 0.001 however at 24 hrs. was 0.272. Participant in group A had extra movements at 0hr, 6hrs and 12hrs with p-value <0.001 as compare to control cut had no significant difference when coughing. Martenal satisfaction with pain management was 95.1% with no reported adverse event.Conclusions: Trans Abdominis Plane block when used as part of multimodal pain management is more effective in managing post cesarean pain resulting in less physical limitation and high martenal satisfaction.Trail registration: Register in Pan African Clinical Trial Registry (PACTR) with no PACTR202011815473426 on 12 November 2020.