A Double-Blind Randomized Controlled Trial for the Evaluation of Efficacy of Transversus abdominis Plane block after Caesarean Delivery

Abstract

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.