A Randomized Comparative Clinical Trial To Know The Efficacy Of Ultrasound Guided Transversus Abdominis Plane Block Against Multimodal Analgesia For Post-Operative Analgesia Following Caesarean Section

Abstract

Introduction: Transversus abdominis plane (TAP) block as a technique of regional anaesthesia which has been applied as one of the segment of pain control regimen in abdominal surgeries including caesarean sections. In this study we have compared the efficacy of TAP Block against multimodal analgesia. Key Words: TAP Block, Caesarean Section, Multimodal analgesia, Bupivacaine. Aims: To study  Reduction of the additional Rescue analgesia 24 hours following caesarean section.  Duration of analgesia, patient satisfaction, adverse effects like- PONV and sedation. Methods: Prospective randomized clinical study was conducted in the department of Anesthesia at B.L.D.E. (DEEMED TO BE UNIVERSITY) Shri B. M. Patil Medical College Hospital and Research Centre, Vijayapur. Ethical Committee permission- Taken Informed written consent- Taken Total of 60 patients scheduled for caesarean section were allotted into two groups. Group I USG-guided Bilateral TAP Block with 15ml of 0.25% Bupivacaine was performed on each side following caesarean section.Group II Received standard analgesia according to Obstetric department protocol consisting Intramuscular(IM) Diclofenac 75mg, Intravenous(IV) Paracetamol(1000mg) and IV Pentazocine 0.5mg/kg body weight stat at the end of surgery. Test used were Chi square test, unpaired t test. Inclusion criteria  American Society of Anesthesiologists(ASA) status II and III.  >18 years of age who is pregnant presenting for a caesarean delivery Exclusion criteria  Inability to consent.  Any contraindication to spinal anaesthesia.  Allergy to local anesthetic agents.  Local infection.  Coagulopathy. Results: Pain on movement and opioid consumption was found to be lesser in TAP Block (17.2 ±10.4mg vs 28.9±24.2mg), VAS was lower in the TAP block group at the end of 24 hour (0.30±0.75 vs 5.27±0.78). Time for the demand of 1st rescue analgesia was prolonged to 8.9 hours from 3.1 hours. Reduced incidence of PONV and Sedation. Conclusion: TAP block is easy to perform under ultrasound guidance and provides effective analgesia with reduced incidence of sedation and PONV.