Comparison of postoperative analgesic effect of transversus abdominis plane block versus direct wound infiltration with local anesthetic for lower segment cesarean section

Abstract

Background: Various drugs and regional blocks are available for providing suitable postoperative analgesia after lower segment cesarean section (LSCS), however commonly used techniques are conventional wound infiltration with local anesthetic and the current technique of transversus abdominis plane (TAP) block. This study aims to compare the analgesic efficacy of TAP block with that of direct infiltration of local anesthetic into a surgical incision in LSCS patients. Materials and Methods: A total of 80 patients for LSCS under subarachnoid block were allocated in two groups; Group A (TAP block, n = 40). TAP block was done by the Anesthesiologist and Group B (wound site infiltration, n = 40); wound site infiltration was done by the operating Surgeon. Postoperative pain, assessed by the Visual Analog Scale (VAS) levels at 2, 6, 12, and 24th h, the requirement of rescue analgesia and patient satisfaction was analyzed. Results: The VAS scores were lower at the 2nd and 4th h (statistically significant) of the postoperative period but at 6th, 12th, and 24th h, though VAS scores in Group A were lower in comparison to Group B, differences were statistically insignificant. The time to administer the first dose of rescue analgesia (421 ± 118.8 min) was longer in Group A in comparison to Group B (187 ± 148.3 min) with significantly fewer cumulative dose and delayed requirement of rescue analgesia in the first 24 h. Conclusions: Wound site infiltration and TAP block did not significantly differ regarding postoperative pain score in post-LSCS patients except the initial 4 h, but the TAP block showed an advantage with significantly reduced cumulative dose and delayed requirement of rescue analgesia in first 24 h.

Keywords

• cesarean section
• obstetric analgesia
• postoperative period
• visual analog scale