Analgesic efficacy and safety of ultrasound guided transverse abdominis plane block in postcesarean section patients—A randomized control trial

Abstract

Context: Following cesarean section, pain is anticipated. An important component of pain after cesarean section is from abdominal wall incision. Transverse abdominis plane (TAP) block can be used as a part of multimodal analgesia for cesarean section. Aims: To assess the analgesic efficacy and safety of ultrasound-guided TAP block in postcesarean section patients. Methods: Sixty patients undergoing cesarean section under spinal anesthesia were included in this randomized control study. They were divided into three equal groups, A, B, and C. All patients received diclofenac suppository 100 mg 12th hourly and intravenous paracetamol 1g 8th hourly after surgery. Group A patients underwent TAP block after the surgery using a total of 40 ml of 0.25% bupivacaine bilaterally. Group B patients underwent TAP block using 20 ml of 0.25% bupivacaine with clonidine 2 μg/kg. Group C patients did not undergo any block. Postoperative blood pressure, heart rate, nausea, vomiting, sedation, and pain score were noted. Kruskal–Wallis test, Chi-square test, and Mann–Whitney test were used for statistical analysis. Results: Patients who received TAP block had prolonged analgesia. The mean time to rescue analgesia was 8.6 ± 2.8, 7.9 ± 3.8, and 3.5 ± 3.1h for groups A, B, and C, respectively. The pain scores in group A and B were less than group C. Comparison of pain score between group A and B did not show any statistical difference. Conclusion: Ultrasound-guided TAP block is a safe and effective method of providing postoperative analgesia in caesarean patients. Addition of clonidine does not provide any additional benefit.

Keywords

• cesarean section
• clonidine
• postoperative analgesia
• spinal anesthesia
• transverses abdominis plane block
• ultrasound-guided