Local and Regional Anesthesia (Apr 2024)
Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study
Abstract
Jorge Emilio Salazar-Flórez,1 Leidy Tatiana Arenas-Cardona,2 Ninemy Marhx,2 Eduardo López-Guerrero,2 Ángela Patricia Echeverri-Rendón,1 Luz Stella Giraldo-Cardona1 1Department of Medicine, San Martín University Foundation, Sabaneta, Antioquia, Colombia; 2Department of Medicine, Hospital General de Occidente, University Health Sciences Center of University of Guadalajara, Jalisco, MexicoCorrespondence: Jorge Emilio Salazar-Flórez, Faculty of Medicine, San Martín University Foundation, Calle 75 sur # 34-50, Block 2, Sabaneta, Antioquia, Colombia, Tel +604-5906983 – 5025, Email [email protected]: Effective post-operative analgesia profoundly influences patient recovery and outcomes after caesarean delivery. The Transversus Abdominis Plane (TAP) block represents a potential alternative, potentially offering greater effectiveness than epidural analgesia while causing fewer adverse effects.Objective: To assess if the abdominal transverse block provides superior postoperative pain relief in patients undergoing caesarean delivery compared to epidural analgesia.Methods: Participants were divided into parallel groups: an experimental group receiving TAP block (n=25) and a control group receiving epidural analgesia (n=24). All patients received a 10 mg dose of hyoscine at the end of the surgery. Experimental Group received a total of 20 mL of 0.2% ropivacaine. In Epidural group received 0.2% ropivacaine at 4 mL/h for 24 hours. All participants were administered combined with neuroaxial block anesthesia. The patients selected for epidural analgesia received the mentioned dose, while the other group block had the epidural catheter removed after the cesarean section. The primary outcome was post-caesarean pain, evaluated using the Visual Analog Scale (VAS) at four intervals (0, 6, 12, and 24 hours). Also, surgical bleeding and residual motor were evaluated. VAS pain scores between the groups were compared using the Friedman test and Generalized Linear Model (GLM) for non-normally distributed data. The effect size was estimated with Eta Square (), considering values ≥ 0.38 as indicative of large effects. A two-tailed p-value < 0.05 was deemed statistically significant.Results: Statistically significant differences in pain scores were noted at 0 and 6 hours post-surgery (p< 0.01). The TAP block group reported lower pain scores at 0 hours (mean=0.04) and 6 hours (mean=1.16) compared to the epidural group, reflecting a substantial effect size.Conclusion: The TAP block proves advantageous in mitigating postoperative pain for women post-caesarean delivery, particularly in the initial 6 postpartum hours. This relief promotes early mother-infant bonding and facilitates breastfeeding.Keywords: analgesics, anesthetics, transverse abdominis plane block, epidural, cesarean section, pain
