Multimodal analgesia for cesarean section: Evolving role of transversus abdominis plane block

Background and Aims:Transversus abdominis plane (TAP) block is a fascial plane block providing post-operative analgesia in patients undergoing surgery with infra-umbilical incisions. We evaluated analgesic efficacy of TAP block with ropivacaine for 24 h after caesarean section through a Pfannenstiel incision.Methods:Sixty patients undergoing caesarean section under spinal anaesthesia were randomised to undergo TAP block with ropivacaine (n = 30) versus control group (n = 30) with normal saline, in addition to standard analgesia with intravenous paracetamol and tramadol. At the end of the surgery, ultrasound-guided TAP plane block was given bilaterally using ropivacaine or normal saline (15 ml on either side). Each patient was assessed post-operatively by a blinded investigator at regular intervals up to 24 h for visual analogue score (VAS) and requirement of analgesia. SPSS version 18.0 software was used. Demographic data were analysed using Student's t-test and the other parameters using paired t-test.Results:TAP block with ropivacaine compared with normal saline reduced post-operative VAS at 24 h (P = 0.004918). Time for rescue analgesia in the study group was prolonged from 4.1 to 9.53 h (P = 0.01631). Mean requirement of tramadol in the first 24 h was reduced in the study group.Conclusion:US guided TAP block after caesarean section reduces the analgesic requirement in the first 24 h.

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“…We hypothesised that ultrasonography (USG)-guided TAP block reduces requirement of opioids and provides effective and adequate analgesia. [ 2 ]…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided transversus abdominis plane block for post-operative analgesia in patients undergoing caesarean section

2016

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“…USG-guided bilateral TAP block was given to Group B patients by in plane approach using the MINDRAY Ultrasonography machine with linear array transducer probe (8)(9)(10)(11)(12)(13)(14). Patients who were randomized to Group C were also prepared for block and scanned by USG, but no block was given.…”

Section: Methodsmentioning

confidence: 99%

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

Prajapati¹,

Brahmbhatt²

2021

IJCA

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Transversus abdominis plane block is facial plane block providing post-operative analgesia after lower abdominal surgeries as part of multi-modal analgesia. We evaluated analgesic efficacy of TAP block with Bupivacaine for 24hr after caesarean section done with pffannestiel incision under spinal anaesthesia, the pain being assessed with help of VAS. Total 130 parturients (ASA I OR II) posted for elective caesarean section under spinal anaesthesia were enrolled. They were allocated randomly in to two groups of 65 each. Group B patients received bilateral TAP block under USG at the end of surgery with 15ml of 0.25%Bupivacaine on each side while Group C patients did not receive TAP block. IV paracetamol 1gm was given in both groups as baseline analgesic at the end of surgery. Post-operative pain was assessed with VAS and rescue analgesia was given in form of Inj. Diclofenac Sodium Aq. at VAS score>4. Total rescue analgesia required in mg in post-operative 24 hours was noted.USG guided TAP block after caesarean section produced effective analgesia. Time for 1st rescue analgesia was delayed in group-B (mean+SD-12.25+4.54hr) than group-C (7.96+2.89hr) (P<0.001). Total analgesic requirement was reduced in group-B (107.35+50.32mg) than group-C (183+52.83mg) (P<0.001). USG-guided TAP block is easy to perform and effective as a component of multimodal analgesic regimen after caesarean section without any major complications.

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“…Transverse abdominis plane (TAP) block is a regional technique that blocks abdominal wall neural afferents between T6 and L1 and thus can relieve pain associated with [4,5] an abdominal incision.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Efficacy of Levobupivacaine in Transverse Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Caesarean Section: A Double Blinded, Randomized Study

Praveen

Mishra

2020

Global Journal for Research Analysis

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Background: Dexamethasone has a long and efficient glucocorticoid structure and presents anti-inflammatory properties. When used as an adjuvant to local anaesthetics, it prolongs the duration of analgesia. The aim of this study was to determine the effect of dexamethasone as an adjuvant to levobupivacaine in TAP block given to patients who underwent caesarean section. Materials & Methods: 70 patients posted for caesarean section under spinal anaesthesia were included in the study and divided into two groups. Group A received bilateral 30 ml 0.25% levobupivacaine and 2 ml dexamethasone(8mg). Group B received bilateral 30 ml 0.25% levobupivacaine and 2 ml 0.9% NaCl in a TAP block performed with ultrasonography. The time needed for the first rescue analgesia in the postoperative period was recorded. 24hr tramadol consumption & VAS was recorded. Results: Time for first analgesic administration (tramadol) was prolonged significantly in Group A (mean ± SD- 12.24 ± 1.22hrs) as compared to Group B (mean ± SD ‑ 8.37± 1.07 hrs), P < 0.0001. Tramadol requirement for 24hrs in Group A was 115.71± 16.89 mg and for Group B was 198.57± 22.64 mg, which was statistically significant (P < 0.0001). VAS was noted at 2, 4, 6, 8, 12, 18 and 24 h. VAS was greatly reduced in group A for the first 8–10 h post‑operatively as compared to patients in group B. CONCLUSIONS: Dexamethasone when used as an adjuvant to levobupivacaine in TAP block, enhances the duration of block & decreases opioid consumption in the post- caesarean section patients.

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Multimodal analgesia for cesarean section: Evolving role of transversus abdominis plane block

Cited by 8 publications

References 18 publications

Ultrasound-guided transversus abdominis plane block for post-operative analgesia in patients undergoing caesarean section

Ultrasound-guided transversus abdominis plane block for post-operative analgesia in patients undergoing caesarean section

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

Comparison of Efficacy of Levobupivacaine in Transverse Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Caesarean Section: A Double Blinded, Randomized Study

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