Local and Regional Anesthesia (Jun 2024)
Comparison of Spinal Morphine and Transversus Abdominis Plane Block on Opioid Requirements After Caesarean Section: An Observational Study
Abstract
Suwarman,1 Osmond Muftilov Pison,1 Mohammad Fikry Maulana,1 Prapanca Nugraha2 1Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 2Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, IndonesiaCorrespondence: Suwarman; Mohammad Fikry Maulana, Email [email protected]; [email protected]: Acute postoperative pain is one of the major clinical problems that occurs in patients undergoing cesarean section with a prevalence of 89.8%. Postoperative pain causes discomfort and various complications for the mother. In addition, postoperative pain that is not handled properly can increase the risk of becoming chronic pain by 2.5 times. One of the methods recommended in the Enhanced Recovery After Caesarean Section (ERACS) protocol to prevent acute postoperative pain is the use of intrathecal long-acting opioids, with intrathecal morphine as the gold standard and Transversus Abdominis Plane (TAP) block. This study aims to assess the comparison of opioid needs as analgesic rescue between the administration of 0.1mg spinal morphine and TAP block with bupivacaine 0.2% 10mg in patients undergoing cesarean section.Methods: This study is an observational study in a single Tertiary Hospital in West Java – Indonesia. Patients were given patient-controlled anesthesia (PCA) with fentanyl as analgesic rescue. Statistical analysis of the numerical data used the unpaired t-test and Chi-Square test for categorical data.Results: In the group that was given spinal morphine, the duration of additional opioids was longer (p < 0.05), and the total dose of additional opioids was less than the TAP block group (p < 0.05).Conclusion: The spinal morphine requires fewer additional opioids than the TAP block.Plain Language Summary: Sectio caesarea (SC) is one of the most commonly performed surgeries in health care. One of the most common risks of SC is the occurrence of postoperative pain that can interfere with mothers’ physical and mental health. Therefore, the anesthesia technique used must have an optimal effect both in relieving pain during surgery and postoperatively. In addition, the side effects of the anesthesia technique used must also be minimized. This is an observational study comparing the pain relief and side effects between two anesthesia techniques that are often mentioned in the literature, namely the use of morphine in spinal anesthesia and bupivacaine in the Transversus Abdominis Plane (TAP) Block. A total of 44 pregnant women who were indicated to undergo SC were divided into two groups. Pain and side effects subjectively reported by the women were monitored and documented for up to 24 hours postoperatively. Moderate-to-severe pain was an indication of additional pain relief. The results showed that the spinal anesthesia technique with morphine had a better postoperative pain relief effect, characterized by the need for less additional pain relief and a longer time interval to the first additional pain relief. Morphine-treated women experienced more mild side effects such as skin itching, nausea, and vomiting. However, this was not significant. Further research with a larger sample and consideration of other factors that may affect the mother’s subjective pain perception such as histories of previous surgery, medication use, and previous pregnancy will provide more accurate comparative results.Keywords: cesarean section, duration of analgesia, pain scale, spinal analgesia, transversus abdominis plane block
