Transverse Abdominis Plane Block-based Multimodal Analgesia Protocol Reduces Tramadol Need After Cesarean Section

Abstract

Objective:Various strategies of multimodal analgesia exist for pain control following caesarean section, aiming to improve analgesia, reduce opioid requirement, and therefore decrease the incidence of opioid related side effects. This study aimed to compare the analgesic quality and reduction in tramadol need across four different multimodal analgesia strategies after caesarean section with general anesthesia.Method:A total of 160 patients that underwent elective cesarean section under general anesthesia were retrospectively included in one of the following groups: only tramadol-based patient-controlled analgesia, tramadol-based patient-controlled analgesia plus diclofenac suppository, tramadol-based patient-controlled analgesia plus diclofenac suppository plus paracetamol, and tramadol-based patient-controlled analgesia plus diclofenac plus transverse abdominis plane block. Visual analogue scale scores and tramadol use were monitored and recorded at 2nd, 4th, 8th, 12th, and 24th hours.Results:At 2nd, 4th and 8th hours, tramadol-based patient-controlled analgesia-only group had significantly higher visual analogue scale scores than all other groups (p0.05).Conclusion:Tramadol-based patient-controlled analgesia alone does not seem to provide effective pain control following caesarean section under general anesthesia. Multimodal analgesia including transverse abdominis plane block distinguishes itself with its most marked opioid-sparing effect, while paracetamol does not appear to provide additional benefits.

Keywords

• cesarean section
• diclofenac
• paracetamol
• patient-controlled analgesia
• tramadol
• transverse abdominis plane block