Subarachnoid block and ultrasound-guided transversalis fascia plane block for caesarean section

Abstract

BACKGROUND After caesarean section, maternal postoperative comfort is critical to allow the new mother to care for her baby. Insufficient pain relief during the postoperative period may delay maternal/infant bonding and, in addition, such pain has been linked to subsequent depression and chronic pain. Caesarean section is commonly performed with a Pfannenstiel incision, and a transversalis fascia plane (TFP) block provides postoperative analgesia in the T12 and L1 dermatomes. OBJECTIVE The aim of this study was to investigate the effect of the TFP block on postoperative opioid consumption and pain scores in patients undergoing caesarean section under spinal anaesthesia. DESIGN A randomised controlled, double-blind study. SETTINGS Single-centre, academic hospital. PARTICIPANTS Sixty patients undergoing caesarean section. INTERVENTIONS The TFP group (n = 30) received an ultrasound-guided bilateral TFP block with 20 ml of 0.25% bupivacaine. The control group (n = 30) received 20 ml of saline bilaterally. Postoperative analgesia was given every 6 h with intravenous paracetamol 1 g and patient-controlled analgesia (PCA) with morphine. MAIN OUTCOME MEASURES Postoperative visual analogue pain scores, morphine consumption, rescue analgesia and opioid-related side effects were evaluated. RESULTS In the TFP group, the visual analogue pain scores were significantly lower at rest for 2 h after the operation (P = 0.011) and during active movement at 2, 4 and 8 h postoperatively (P = 0.014, <0.001 and 0.032, respectively). Morphine consumption in the first 24 h after surgery was significantly higher in the control group compared with the TFP group (38.5 ± 11.63 and 19.5 ± 8.33 mg, respectively; P < 0.001). The incidence of postoperative nausea and constipation were statistically higher in the control group than in the TFP group (P < 0.05). Patient satisfaction was significantly higher in the TFP group (P = 0.027). CONCLUSION A postoperative TFP block can reduce opioid consumption and relieve acute pain after a caesarean section under spinal anaesthesia. TRIAL REGISTRATION ClinicalTrials.gov, NCT04172727.

The Efficacy and Safety of Local Anesthetic Techniques for Postoperative Analgesia After Cesarean Section: A Bayesian Network Meta-Analysis of Randomized Controlled Trials

“…Safety-related outcomes of local anesthetic techniques may include opioid-related side effects (ie, PONV, pruritus, sedation, respiratory depression, hypotension, and urinary retention), block-related complications (ie, hematoma, organ injury, local anesthetic systemic toxicity, and block failure), and effects on breastfeeding or mother-infant interaction. 84–86 Respiratory depression, 14 , 37 , 51 , 78 hypotension, 32 , 37 , 38 , 53 urinary retention, 31 , 37 , 68 , 72 effects on breastfeeding or mother-infant interaction, 43 , 65 , 77 and block-related complications 37 , 39 , 41 , 43 , 50 , 73 , 80 were rarely reported in the involved study. Therefore, we selected PONV, pruritus, and sedation as the safety outcomes of this NMA.…”

Preemptive analgesic efficacy of ultrasound-guided transversalis fascia plane block in children undergoing inguinal herniorrhaphy: a randomized, double-blind, controlled study

“…Several clinical trials have demonstrated that the TFP block is associated with good postoperative analgesia with reduced analgesic consumption after iliac crest bone graft harvesting [ 5 ] and cesarean section [ 7 , 8 ].…”

“…The analgesic efficacy of TFP block have been demonstrated in adults' surgeries, including iliac crest bone graft harvesting [5], inguinal herniorrhaphy [6] and caesarean section [7,8]. In pediatric surgery, the only report of TFP block was described by Ahiskalioglu et al [9] in two children.…”

“…The analgesic efficacy of TFP block has been demonstrated in adult surgery, including iliac crest bone graft harvesting [ 5 ], inguinal herniorrhaphy [ 6 ], and cesarean section [ 7 , 8 ]. In pediatric surgery, the only report of the TFP block was provided by Ahiskalioglu et al [ 9 ] in two children, one of them underwent unilateral open inguinal herniorrhaphy and the other was scheduled for reimplantation of the ureter into urinary bladder via pfannenstiel incision.…”

“…The only case report of TFP block in children was described by Ahiskalioglu et al [9] who performed TFP block in two children with similar results to that of our study, one of them was 5 years old girl scheduled for uretero-cystostomy via Pfannenstiel incision and the other child was 4 years boy scheduled for unilateral inguinal herniorrhaphy and they reported improved postoperative analgesia in both cases. Several clinical trials have demonstrated that TFP block is associated with good postoperative analgesia with reduced analgesic consumption after iliac crest bone graft harvesting [5] and cesarean section [7,8].…”