Postoperative Analgesia of Transversus Abdominis Plane Block After Cesarean Delivery Under General Anesthesia

Abstract

Cesarean delivery under general anesthesia requires effective postoperative analgesia for early ambulation and breast feeding. Transversus abdominis plane (TAP) block is done by injecting local anesthetic solution in the plane between internal oblique and transversus abdominis muscles on either sides of the abdominal wall to prolong postoperative analgesia. One hundred pregnant women who underwent general anesthesia for cesarean delivery were randomized in to two equal groups;TAP block group versus control group. This block was performed bilaterally using 20 mls of 0.25% plain bupivacaine on each side. Each patient was assessed postoperatively by a blinded investigator at 2, 4, 6,12, 24 hours using numerical pain score (NPS) 0-10 at rest and movement. Narcotics consumption, drug side effects, and patient`s satisfaction were recorded. There were no significant differences between patients characteristics. Postoperative pain at rest as measured by NPS showed; medians (3-6) and means (3-5.5) in the control group; which were significantly (p<0.05) higher than those in TAP block group which did not exceed. During movement, NPS medians (4.5-8) and means (4.5-8.5) in the control group were significantly (p<.05) higher than those in TAP block group where never exceeded. Narcotic consumptions decreased to 50% in TAP block group. Pethidine requested by 30% of patients in the control group versus 14% of TAP group. Unilateral block observed in 1/50 (0.02%), no other complications reported from TAP block. Patients satisfactions for analgesia rated good by 82% in TAP block group versus 40% in control group. In conclusion, transversus abdominis plane block provides good & prolonged postoperative analgesia after cesarean delivery performed under general anesthesia when it is combined to multimodal analgesia.