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

Karatepe, Umit; Özer, Ayşe Belin

doi:10.4066/biomedicalresearch.29-17-3880

Cited by 7 publications

(17 citation statements)

References 15 publications

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“…However, despite these benefits, spinal anesthesia does not provide adequate postoperative pain relief. 2 Various techniques are used for postoperative pain relief after cesarean delivery under spinal anesthesia, including intrathecal and/or systemic opioids, abdominal nerve blocks, and truncal blocks such as the transversus abdominis plane (TAP) block with parenteral analgesics and bilateral erector spinae plane (ESP) block. 3,4 TAP block has gained popularity as an effective analgesia technique in mothers undergoing cesarean delivery and works by blocking the anterior rami of the spinal nerves of the abdominal anterior wall after spreading of the local anaesthetic agent in the neurofascial plane between the internal oblique and transversus abdominis muscle, thereby relieving the pain of cesarean section.…”

Section: Introductionmentioning

confidence: 99%

<p>Comparison of Analgesic Effect Between Erector Spinae Plane Block and Transversus Abdominis Plane Block After Elective Cesarean Section: A Prospective Randomized Single-Blind Controlled Study</p>

Boules¹,

Goda²,

Abdelhady³

et al. 2020

JPR

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Background: This study compared the analgesic efficacy of a bilateral erector spinae plane (ESP) block with that of a bilateral transversus abdominis plane (TAP) block after elective cesarean delivery. Methods: Sixty mothers scheduled for elective cesarean delivery under spinal anesthesia were randomly allocated to receive either ESP block or TAP block. The ESP group received ESP block at the level of the ninth thoracic transverse process with 20 mL of 0.25% bupivacaine at the end of surgery. The TAP group received an ultrasound-guided TAP block with 20 mL of 0.25% bupivacaine on completion of delivery. The primary outcome was the duration of analgesia achieved by each block. Secondary outcome measures were the postoperative pain severity, total tramadol consumption, patient satisfaction. Results: The median (interquartile range) duration of block was longer in the ESP group than in the TAP group (12 hours [10, 14] vs 8 hours [8, 8], p<0.0001). In the first 24 hours, the mean visual analog pain score at rest was lower by 0.32 units in the ESP group. The median tramadol consumption in the first 24 hours was significantly higher in the TAP group than in the ESP group (125 mg [100, 150] vs 100 mg [75, 100, p=0.003]). Conclusion: Compared with the TAP block, the ESP block provides more effective pain relief, has a longer duration of analgesic action, prolongs time to first analgesic requirement, is associated with less tramadol consumption, and can be used in multimodal analgesia and opioid-sparing regimens after cesarean section.

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Section: Introductionmentioning

confidence: 99%

<p>Comparison of Analgesic Effect Between Erector Spinae Plane Block and Transversus Abdominis Plane Block After Elective Cesarean Section: A Prospective Randomized Single-Blind Controlled Study</p>

Boules¹,

Goda²,

Abdelhady³

et al. 2020

JPR

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“…Hasil ini serupa dengan penelitian menggunakan blok TAP yang dipandu dengan USG, yaitu menurunkan intensitas nyeri dalam 24 jam pertama pasca operasi caesar serta menurunkan kebutuhan analgesik lainnya, karena pada kelompok kontrol memerlukan tambahan beberapa dosis injeksi tramadol pada 24 jam setelah operasi caesar. 7,8 Penelitan yang dilakukan untuk melihat penyebaran injeksi setelah blok TAP menggunakan USG menyatakan bahwa saraf T10-L1 pada bidang transversus abdominalis dapat terpengaruh dengan volume 20 ml lokal anestesi.…”

Section: Efektivitas Blok Transversus Abdominis Plane Pasca Operaunclassified

“…Asalkan diberikan volume yang cukup, maka memungkinkan untuk mencapai analgesia yang berlangsung sekitar 24-48 jam. 7 Dalam sebuah penelitian lain untuk mengevaluasi keefektivan blok TAP pasca operasi caesar diamati bahwa aplikasi blok TAP yang dipandu dengan bantuan USG pada pasien yang menjalani operasi caesar di bawah anestesi spinal mengakibatkan penurunan rasa nyeri, mengurangi konsumsi opioid pada periode pasca operasi dan efek samping terkait opioid, serta peningkatan kenyamanan pasien. Selain itu, secara signifikan meningkatkan akurasi dari penginjeksian anestesi lokal dan mengurangi kejadian efek samping sehingga semakin mempopulerkannya sebagai analgesia blok saraf pasca operasi caesaria.…”

Section: Efektivitas Blok Transversus Abdominis Plane Pasca Operaunclassified

“…Selain itu, secara signifikan meningkatkan akurasi dari penginjeksian anestesi lokal dan mengurangi kejadian efek samping sehingga semakin mempopulerkannya sebagai analgesia blok saraf pasca operasi caesaria. 7,9,10 Penelitian yang dilakukan dimana melibatkan pasien yang menjalani operasi caesar dengan anestesi umum menunjukan bahwa aplikasi blok TAP yang dipandu dengan bantuan USG menghasilkan pengurangan konsumsi morfin dalam 24 jam pertama dan skor VAS pasca operasi yang lebih rendah. Selain itu, evaluasi efektivitas blok TAP yang dilakukan setelah anestesi spinal juga menunjukkan penurunan skor VAS serta konsumsi analgesik yang terkait dengan prosedur.…”

Section: Efektivitas Blok Transversus Abdominis Plane Pasca Operaunclassified

“…Hasil ini juga konsisten dengan sebuah penelitian meta-analisis tentang manfaat utama dari blok TAP yaitu ditemukannya pengurangan konsumsi morfin pasca operasi caesar dibandingkan dengan pasien yang menerima agen tidak aktif (termasuk plasebo dan perawatan standar). 7,11 Sebuah meta-analisis yang meninjau 7 penelitian yang melibatkan blok TAP setelah anestesi umum dan 2 penelitian yang melibatkan blok TAP setelah anestesi spinal menyimpulkan bahwa aplikasi blok TAP memiliki kontribusi yang signifikan dalam manajemen nyeri pasca operasi caesar dalam kasus anestesi spinal yang tidak melibatkan penambahan injeksi opioid intratekal. Adapun aplikasi anestesi spinal yang melibatkan penambahan opioid, dalam penelitian ini tidak menunjukan efek yang signifikan dari blok TAP.…”

Section: Efektivitas Blok Transversus Abdominis Plane Pasca Operaunclassified

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Efektivitas Blok Transversus Abdominis Plane Pasca Operasi Caesar

Suharto

Saputra

2020

JAOI

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Operasi caesar merupakan prosedur bedah yang paling umum dilakukan di seluruh dunia. Operasi ini menyebabkan nyeri pasca operatif sedang hingga berat sebagai akibat insisi pfannenstiel yang umumnya dikaitkan dengan rasa nyeri pada uterus dan somatik pada dinding abdomen. Analgesia pasca operasi yang memadai pada pasien obstetrik sangat penting karena mereka memiliki kebutuhan pemulihan bedah yang berbeda, yaitu meliputi menyusui dan perawatan bayi baru lahir, hal ini dapat terganggu jika analgesia yang diberikan tidak memuaskan. Rejimen analgesik pasca operasi yang ideal harus efektif tanpa mempengaruhi ibu untuk merawat neonates dan dengan efek transfer obat yang seminimal mungkin melalui ASI. Saat ini banyak cara yang paling aman dan efektif dari intervensi manajemen nyeri pasca operasi seperti anestesi lokal dengan infiltrasi kulit, analgesia epidural, dan blok bidang seperti blok transversus abdominis plane (TAP) dan blok ilioinguinal-iliohipogastrik (II-IH). Blok TAP merupakan teknik anestesi regional dimana serabut saraf aferen yang menginervasi dinding abdomen bagian anterolateral diblokir dengan mengguakan anestesi lokal di bidang transversus abdominalis. Potensinya dalam meningkatkan kualitas dan durasi analgesia setelah berbagai operasi abdomen bawah sudah tidak bisa dipungkiri lagi. Sekarang, dengan bantuan USG menjadikan blok TAP sebagai metode yang aman dan efektif untuk memberikan analgesia pasca operasi caesar dibandingkan dengan perawatan standar pasca operasi. Selain itu, blok TAP juga dikaitkan dengan pengurangan konsumsi opioid, peningkatan kepuasan pasien, dan efektif untuk mengurangi nyeri dibandingkan dengan teknik analgesia lainnya. Efficacy of Transversus Abdominis Plane Block After Post Caesarean Section Delivery Abstract Caesarean section is the most common surgical procedure performed worldwide. This operation causes moderate to severe postoperative pain as a result of pfannenstiel incision which is commonly associated with pain in the uterus and somatic in the abdominal wall. Adequate postoperative analgesia in obstetric patients is very important because they have different surgical recovery needs, which include breastfeeding and newborn care, this is can be disrupted if the analgesia given is not satisfactory. The ideal postoperative analgesic rejimen must be effective without affecting the mother to treat the neonate and with minimal effect of drug transfer through breast milk. There are currently many of the safest and effective ways of interventions for postoperative pain management such as local anesthetic skin infiltration, epidural analgesia, and field block like TAP and II-IH. TAP block is a regional anesthetic technique where afferent nerve fibers that innervate the anterolateral abdominal wall are blocked by using local anesthesia in the transverse abdominal plane area. Potential in improving the quality and duration of analgesia after various lower abdominal operations is inevitable. Now, with ultrasound guiding, the TAP block is a safe and effective method for providing analgesia post caesarean section delivery compared to standard postoperative care. In addition, TAP block is also associated with a reduction of opioid consumption, increased patient satisfaction, and is effective in reducing pain compared to other analgesia technique.

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Efficacy of regional blocks or local anaesthetic infiltration for analgesia after caesarean delivery: a network meta‐analysis of randomised controlled trials

et al. 2021

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Caesarean delivery is common and can cause severe postoperative pain but injection of local anaesthetic at various sites for regional blocks or local anaesthetic infiltration may reduce this. We aimed to compare and rank these sites. We searched PubMed, Google Scholar, EMBASE and CENTRAL to June 2021 for randomised controlled trials and performed a random-effects Bayesian model network meta-analysis. The primary outcome was dose of parenteral morphine equivalents in the first 24 postoperative hours. We used surface under cumulative ranking probabilities to order techniques. We analysed 114 trials (8730 participants). The ordered mean (95% credible interval) reduction in morphine equivalents, from 34 mg with placebo, were as follows: ilioinguinal 15 (1-32) mg; ilio-inguinal-iliohypogastric 13 (6-19) mg; transversalis fascia 11 (4-26) mg; erector spinae 11 (10-32); transverse abdominis 9 (4-13) mg; wound catheter infusion 8 (2-15) mg; quadratus lumborum 8 (1-15) mg; wound infiltration 8 (2-13) mg; and no intervention À4 (À10 to 2) mg. Ordered efficacies for injection sites were different for other relevant outcomes, including pain (to 4-6 h and to 24 h) and time to rescue analgesia: there was no single preferred route of injection. The ordered mean (95% credible interval) reduction in dynamic pain scores (0-10 scale) at 24 h compared with placebo were as follows: wound infusion 1.2 (0.2-2.1); erector spinae 1.3 (À0.5 to 3.1); quadratus lumborum 1.0 (0.1-1.8); ilio-inguinaliliohypogastric 0.6 (À0.5 to 1.8); transverse abdominis 0.6 (À0.1 to 1.2); wound infiltration 0.5 (À0.3 to 1.3); transversalis fascia À0.8 (À3.4 to 1.9); ilio-inguinal À0.9 (À3.6 to 1.7); and no intervention À0.8 (À1.8 to 0.2). We categorised our confidence in effect sizes as low or very low.

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

Cited by 7 publications

References 15 publications

<p>Comparison of Analgesic Effect Between Erector Spinae Plane Block and Transversus Abdominis Plane Block After Elective Cesarean Section: A Prospective Randomized Single-Blind Controlled Study</p>

<p>Comparison of Analgesic Effect Between Erector Spinae Plane Block and Transversus Abdominis Plane Block After Elective Cesarean Section: A Prospective Randomized Single-Blind Controlled Study</p>

Efektivitas Blok Transversus Abdominis Plane Pasca Operasi Caesar

Efficacy of regional blocks or local anaesthetic infiltration for analgesia after caesarean delivery: a network meta‐analysis of randomised controlled trials

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