Transversus abdominis plane block versus wound site infiltration using 0.25% bupivacaine for post-operative analgesia after caesarean delivery performed under subarachnoid block

Abstract

: Transversus abdominis planeTAP) block has been described as an effective technique to reduce postoperative pain after caesarean section. Wound site infiltration (WSI) has been a traditional method for pain relief. In our study we attempt to compare the analgesic effect of TAP block with wound site infiltration after caesarean section. A randomized comparative study was conducted on 60 parturients. Patients were randomized into Group T (TAP block, n=30) and Group I (WSI, n=30). Spinal anaesthesia was administered and at the end of surgery, Group T was administered TAP block with 20 ml of 0.25% of bupivacaine on each side and in Group I, 20 ml of 0.25% bupivacaine was infiltrated along the wound site. Postoperatively parameters assessed were time to first rescue analgesia, postoperatively patient’s Numeric pain score (NPS) which was assessed periodically over 24hrs and if NPS ≥4 or patient demanded rescue analgesia, Inj diclofenac 75mg i/m was given as first rescue analgesic, total number of doses of first rescue analgesic given over 24hrs, total number of second rescue analgesic and complications were assessed.: The mean time to first rescue analgesia in Group T was 13.40±4.51 hours and in Group I was 6.20±4.25 hours (p-0.001). NPS at 2, 4,6,12 and 24 hours were lower in Group T compared to Group I. Also, analgesic requirement in first 24hours was significantly less in Group T (p-0.001).: TAP block was found to be superior to wound site infiltration in providing effective postoperative pain relief in patients undergoing caesarean section.

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

“…We included 114 trials (8730 women) in our final network analysis, 73 (64%) of which reported the primary outcome of morphine equivalent dose in the first 24 postoperative hours for 5126 (59%) women (Fig. 1 and online Supporting Information, Table S1) [14–127]. Placebo vs. transversus abdominis plane injection in 11 trials was the most common direct comparison.…”