The new trending pain-free cesarean section: TAP block versus IV PCA

Abstract

Background Women's pain satisfaction post-cesarean section remains a challenge. Accurate assessment of pain severity of post-cesarean section helps to choose the most appropriate anesthetic approach, drug, and dose, as well as improvement of treatment of postoperative pain. Our objective was to compare the efficacy of ultrasound-assisted transversus abdominis plane (TAP) block versus IV patient-controlled analgesia (PCA) in the first 24 h postoperative in women who underwent cesarean section. The primary outcome was postoperative pain at 2, 4, 6, 12, and 24 h. The secondary outcomes were intestinal mobility, early mobilization, nausea, vomiting, heart rate, and respiratory rate. Results A cross-sectional study has been conducted on 70 women who are planned for elective cesarean section. They were divided into 2 groups; “group A” (n = 35), women who received TAP block, and “group B” (n = 35), those who received PCA. Pain score, heart rate, respiratory rate, intestinal motility, nausea, and vomiting have been assessed 2, 4, 6, 12, and 24 h postoperatively. The degree of pain was significantly lower in “group B” than in “group A” in all time intervals (p < 0.001). Heart rate was significantly higher in women in “group B” compared to those in “group A” only at 2 and 4 h postoperative (p < 0.001). Nausea and vomiting were also significantly higher in women in “group B” compared to those in “group A” (p value 0.03 and 0.04, respectively). Regarding intestinal motility, it was audible in “group A” earlier than in “group B.” Conclusions Both TAP block and PCA are effective in postoperative pain relief after cesarean section; however, PCA is more superior, especially for visceral pain. Nevertheless, TAP block has the privilege of avoiding systemic action of opioids used in PCA. PCA can easily be applied while TAP block needs more training and an intraoperative ultrasound machine. Complications and side effects of both were minimal when adjusting the doses.

Intravenous lipid emulsion for local anaesthetic systemic toxicity in pregnant women: a scoping review

“…With the increase of caesarean sections worldwide, the management and treatment of LAST in pregnant women is an increasingly important issue [ 63 ]. Anaesthetists use local anaesthesia more often than general anaesthesia in pregnant women [ 30 ].…”

Pentazocine with rectal diclofenac versus pentazocine alone for pain relief following caesarean delivery in Enugu, Nigeria: A randomized controlled trial

“…Recently, there has been increased used of other analgesic modalities following caesarean delivery. 23 – 25 TAP block has been advocated recently. 23 , 24 A previous study compared multimodal analgesia similar to this current study with TAP and found less need for opioids and better VAS scores.…”

“… 23 – 25 TAP block has been advocated recently. 23 , 24 A previous study compared multimodal analgesia similar to this current study with TAP and found less need for opioids and better VAS scores. 31 Other studies have shown more beneficial effects of TAP compared with opioids and NSAIDs when used alone or in combination.…”

“…[20][21][22] Recently, there has been newer techniques of trying to achieve optimum analgesia after caesarean deliveries. [23][24][25] All of these techniques aim to provide a pain-free caesarean delivery. These modalities include transversus abdominis plane (TAP) block, ilioinguinal-iliohypogastric (IL-IH) nerve block, wound infiltration/infusion, ketamine and the use of gabapentin.…”

“…These modalities include transversus abdominis plane (TAP) block, ilioinguinal-iliohypogastric (IL-IH) nerve block, wound infiltration/infusion, ketamine and the use of gabapentin. 23 , 24 All of these newer techniques have been developed to reduce the dose of opioids required after caesarean delivery. However, most of these newer non-opioid techniques are not readily available in public hospitals in our environment.…”