Efficacy of Trans-abdominis Plane Block for Post Cesarean Delivery Analgesia in Low-income Countries: a Phase Three Feasibility Study (original) (raw)
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Journal of Anesthesia & Critical Care: Open Access, 2015
Background: Patients after Cesarean Section go through post operative pain. Most of this pain is experienced after the abdominal wall incision. Transversus abdominis plan (TAP) block as part of multimodal analgesia is a novel approach for patients delivered by cesarean section (CS). This technique (TAP block) lends itself particularly well to resource-poor settings as it does not require a nervestimulator. The aim of this study was to evaluate the efficacy of transversus abdominis plane (TAP) block when it is used as part of multimodal analgesia on obstetric patients after Cesarean Section. Methods: Institution based prospective cohort study design was conducted on patients, who have Cesarean Section from February to May, 2015. All patients operated under spinal anesthesia for cesarean delivery were included. Patients divided into TAP block (n=20) and controls (n=20). The TAP block group was given bilateral 20 ml of 0.25% bupivacaine at the end of surgery. Postoperative pain was assessed within the first 24 hours i.e. at 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours using 100 mm long visual analogue scale (VAS), total analgesic consumption and time for the first analgesic request. Result: There was reduction of VAS scores within the first 24 hours after cesarean section in TAP block group compared with the control group. VAS scores as median(IQR) at 2 hours 0.
Evaluation of Transversus Abdominis Plane Block for Analgesia after Cesarean Section
Journal on Recent Advances in Pain, 2015
Background: This study is intended to evaluate the transversus abdominis plane (TAP) block for analgesia over the first 24 postoperative hours after lower segment cesarean section. Materials and methods: Fifty female parturients of American society of Anesthesiologists (ASA) physical status II undergoing lower segment cesarean section were randomized to undergo a bilateral TAP block with ropivacaine (group 1 = 25) or to undergo a bilateral TAP block with 0.9% saline (group 2 = 25). In addition, all patients received standard analgesic injection tramadol 100 mg and im injection diclofenac 75 mg as required in the postoperative period. All patients received standard spinal anesthesia, and TAP block was performed at end of the surgery. Each patient was assessed after operation at each half an hours up to 24 hours after surgery in postoperative period. Results: The mean visual analog scale (VAS) score of group 1 was statistically less than mean VAS score of group 2 (p < 0.001). The mean of total number analgesic requirement for first 24 hours postoperatively was significantly less in group 1 (1.68 ± 0.9) than group 2 (2.8 ± 0.33) respectively. Conclusion: Transversus abdominis plane block holds considerable promise as part of a multimodal analgesic regimen for post cesarean delivery analgesia. Transversus abdominis plane block is easy to perform and provided reliable and effective analgesia.
Transverse Abdominis Plane Block For Management Of Postoperative Cesarean Section Pain
2021
Background: pain after Cesarean delivery (CD) can negatively affect ambulation, breastfeeding, and maternal bonding. The aim of this study was to determine whether a correctly performed TAPB can provide better control of acute postoperative pain during the first 48 hours after CS and if it can provide a faster postoperative recovery. Patients and methods: included 32 participants who underwent elective caesarean section assigned randomly into two groups. Group A: 16 patients received TAP block. Group B: 16 patients did not receive any block. Medicine Ten centimeters visual analog scale (VAS) was also explained during preoperative visit. The postoperative pain was evaluated at 1, 2, 4, 8, 12, 18 and 24 hours by using VAS for pain scoring that was explained to the patients during preoperative visit as a 100 millimeter horizontal line with verbal anchors at both ends. Results: Our study showed that there is statistically significant difference between the studied groups regarding VAS p...
Panacea Journal of Medical Sciences, 2023
Abstract Background: The present study was conducted to evaluate the postoperative analgesic efficacy of Transversus abdominis plane block after caesarean section and to compare it with patients who were managed conventionally without the TAP Block. Materials and Methods: The present study was conducted as a comparative study at Department of Anaesthesiology, Hamidia Hospital for a period of 1 year among 100 females undergoing caesarean section. All the selected women were randomly divided into two groups of 50 patients each. Hemodynamic parameters, pain and postoperative analgesic requirement was observed and compared between two groups. Results: Pain at various interval of time was significantly lower in TAP block group as compared to control group (p<0> Conclusion: TAP block is effective in providing postoperative analgesia among women undergoing LSCS. It is one of the excellent multimodal analgesia technique and significantly reduces the opioid requirements during postoperative period. TAP block was easy to perform, and provided reliable and effective analgesia in this study, and no complications due to the TAP block were detected. Keywords: TAP block, ropivacaine, pain, tramadol
Obstetric Anesthesia Digest, 2008
BACKGROUND: The transversus abdominis plane (TAP) block is an effective method of providing postoperative analgesia in patients undergoing midline abdominal wall incisions. We evaluated its analgesic efficacy over the first 48 postoperative hours after cesarean delivery performed through a Pfannensteil incision, in a randomized controlled, double-blind, clinical trial. METHODS: Fifty women undergoing elective cesarean delivery were randomized to undergo TAP block with ropivacaine (n ϭ 25) versus placebo (n ϭ 25), in addition to standard postoperative analgesia comprising patient-controlled IV morphine analgesia and regular diclofenac and acetaminophen. All patients received a standard spinal anesthetic, and at the end of surgery, a bilateral TAP block was performed using 1.5 mg/kg ropivacaine (to a maximal dose of 150 mg) or saline on each side. Each patient was assessed postoperatively by a blinded investigator: in the postanesthesia care unit and at 2, 4, 6, 12, 24, 36, and 48 h postoperatively. RESULTS: The TAP block with ropivacaine compared with placebo reduced postoperative visual analog scale pain scores. Mean (Ϯ sd) total morphine requirements in the first 48 postoperative hours were also reduced (66 Ϯ 26 vs 18 Ϯ 14 mg, P Ͻ 0.001), as was the 12-h interval morphine consumption up to 36 h postoperatively. The incidence of sedation was reduced in patients undergoing TAP blockade. There were no complications attributable to the TAP block. CONCLUSIONS: The TAP block, as a component of a multimodal analgesic regimen, provided superior analgesia when compared with placebo block up to 48 postoperative hours after elective cesarean delivery.
Saudi Journal of Anaesthesia, 2015
Systemic or neuraxial opioids are the mainstay for treating postoperative pain, as they are effective against both the components. However, they are associated with a number of undesirable side effects such as nausea, vomiting, pruritus, constipation, and respiratory depression. [4,5] Nonsteroidal anti-inflammatory drug alone may be insufficient to treat postcesarean pain. Currently, multimodal analgesic technique involving abdominal nerve block with parenteral analgesics is becoming popular for these patients. Transverse abdominis plane (TAP) block is a recently introduced regional technique that blocks abdominal wall neural afferents between T6 and L1 and thus can relieve pain associated with an abdominal incision. [6,7] TAP is a neurovascular plane located between the internal oblique and transverse abdominis muscles and nerves supplying abdominal wall pass through this plane before supplying anterior abdominal wall. [8] Therefore, if the local anesthetic is deposited in this space, myocutaneous sensory blockade results.
The analgesic efficiency of transversus abdominis plane (TAP) block after caesarean delivery
Ginekologia Polska, 2018
Objectives: The ultrasound-guided transversus abdominis plane (TAP) block is a supporting method of pain relief after different types of surgical and gynecological procedures. The aim of the present study was to evaluate the analgesic effects of the TAP-block in patients undergoing caesarean section. Material and methods: 88 women undergoing elective caesarean section under spinal anaesthesia were prospectively randomized into two groups. In the first group, an ultrasound-guided bilateral TAP block was performed using 40 mL 0.25% bupivacaine, while the second group was treated without a regional nerve block. Both groups received a standard analgesia protocol with intravenous paracetamol administered every 6 hours and intravenous tramadol on-demand, delivered using the Patient Controlled Analgesia (PCA) method. Pain intensity was assessed according to the visual analogue scale (VAS) directly after the TAP block and at 3, 6 and 12 hours postoperatively. Any patient complaints and side-effects during the postoperative period were recorded. Results: The TAP block resulted in a significant reduction of pain intensity using the visual analogue scale after 3, 6 and 12 hours (p < 0.05) and a significant decrease in tramadol administration (p < 0.05) during the first 12 hours postoperatively. No significant differences in the heart rate and blood pressure were noted between groups (p > 0.05). There were no complications related to the TAP block. Conclusions: The TAP block is a safe and effective adjunctive method of pain relief after caesarean delivery.
IOSR Journal of Dental and Medical Sciences, 2016
Background and Aim: The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents and providing effective postoperative analgesia in patients undergoing lower abdominal wall surgery. We aimed to evaluate its analgesic efficacy during the first 24 postoperative hours, in patients undergoing caesarean delivery through a Pfannenstiel incision. Also, to evaluate the requirement of additional analgesics in the postoperative period and to study the time required for ambulation. Methods: It was a prospective Randomized Controlled, Double Blinded study done in 60 ASA1 and II female patients undergoing caesarean delivery through a Pfannenstiel incision under a standard spinal anesthesia. These patients were randomly divided in two groups of 30 each. Group A (n =30) received a bilateral TAP block with 15ml of 0.25% bupivacaine on each side versus Group B (n =30) received TAP block with normal saline (placebo). Each patient was assessed postoperatively by a blinded investigator: in the post-anaesthesia care unit and at 15, 30, 45 minutes, 1, 2, 4, 6, 12, 18 and 24 hour after TAP blockade. Results:The TAP block with bupivacaine compared with placebo reduced postoperative visual analogue scale pain scores and categorical pain scores. The mean time to first request for rescue analgesia diclofenac was longer 15.47 hours in patients who received a TAP block with bupivacaine, as compared with 3.17 hours in the control group. The requirement of an additional rescue analgesic drug paracetamol was significantly higher in control group as compared to the patients who received TAP blockade with bupivacaine. The comfort level of mother during first breast feeding was significantly better in patients who received TAP block with bupivacaine (group A) as compared to controls (group B). The mean ambulation time in patients who received TAP block with bupivacaine was significantly less (3.8 hours) as compared with control patients (5.43 hours). Conclusions: The TAP block, as a component of a multimodal analgesic regimen, provided superior analgesia when compared with placebo block up to 24 postoperative hours after elective caesarean delivery and also facilitated early ambulation.
Brazilian Journal of Anesthesiology (English Edition), 2021
Background: Multimodal analgesia (MMA) is the current standard practice to provide postcesarean analgesia. The aim of this study was to compare the analgesic efficacy of quadratus lumborum (QL) block and transversus abdominis plane (TAP) block as an adjunct to MMA. Methods: Eighty mothers undergoing cesarean delivery under spinal anesthesia were randomized to receive either TAP or transmuscular QL block (QLB) with 20 mL 0.375% ropivacaine on each side. Postoperatively, all the subjects were assessed at 2, 4, 6, 8, 12, 18, and 24 hours. The primary outcome was the time to first analgesic request. The secondary outcomes were the pain scores during rest and movement, number of doses of tramadol, postoperative nausea-vomiting, sedation, and mother's satisfaction with the pain management. Results: The median (IQR) time to first analgesic request was 12 (9.25, 13) hours in the QL group and 9 (8.25, 11.37) hours in the TAP group (p = 0.0008). Patients in QL group consumed less doses of tramadol than those in TAP group (p < 0.0001). Pain scores were significantly lower in the QL group at all time points (p < 0.0001) except at 8 th hour when at rest, p = 0.0024, and on movement, p = 0.0028. The maternal satisfaction was significantly higher in the QL group (p = 0.0017). Conclusion: Our study showed the significant delay in time to first analgesic request in QL group patients. Patients in the QL group had lower pain scores, required fewer analgesic supplements, and had more satisfaction. Nausea-vomiting and sedation were comparable.
International Journal of Environmental Research and Public Health
Background: Severe postoperative pain is a significant problem after cesarean sections. Methods: This study was a randomized, controlled trial of 105 patients conducted in two hospitals. All patients were anesthetized spinally for elective cesarean section. Each participant was randomly allocated to one of three study groups: the quadratus lumborum block (QLB) group, the transversus abdominis plane block (TAPB) group, or the control (CON) group. The primary outcome of this study determined acute pain intensity on the visual analog scale (VAS). The secondary outcomes determined morphine consumption and chronic pain evaluation according to the Neuropathic Pain Symptom Inventory (NPSI) after hospital discharge. Results: At rest, the pain intensity was significantly higher in the CON group than in the QLB and TAPB groups at hours two and eight. Upon activity, the pain in the control subjects was more severe than in the QLB and TAPB groups in three and two of five measurements, respectiv...