Comparison of analgesic efficacy of transversus abdominis plane block with local wound infiltration using 0.25% levobupivacaine for post cesarean analgesia: A randomized controlled trial

Abstract

The key component of Enhanced recovery after cesarian section (ERAC) is to improve maternal and child outcome and enhance recovery by dint of effective non opioid based pain control. We aim to compare the efficacy of Transverse abdominis plane (TAP) block with local wound infiltration for postoperative analgesia in cesarian section (CS).Eighty-two patients undergoing caesarean section under spinal anaesthesia were randomized to undergo local wound infiltration(Group I) (n=41) versus landmark guided bilateral TAP plane block (Group T) with 20ml of 0.25% levobupivacaine postoperatively Each patient was assessed post-operatively by a blinded investigator at regular intervals up to 24 h for visual analogue score (VAS). Requirement of analgesia, patient satisfaction, time for the first and second rescue analgesia, and the incidence of side effects was also noted. The median VAS was more in the group I compared to group II and was statistically significant (p=0.0032). The mean time to first rescue analgesia was prolonged in group I (4.060 ± 0.682 hrs) compared to group T (3.302 ± 0.519 hrs)(P< 0.001). The mean total analgesic requirement in 24 hours was reduced in group T (89.63 ± 41.82) as compared to group I (137.2 ± 33.13) (P<0.001. Group (T) compared to group I patient had a higher mean patient satisfaction score (1.487 ± 0.589) (2.097 ± 0.430) respectably (P < 0.001).TAP block provides better quality of analgesia and can be safely incorporated as a part of multi-model analgesic regimen postoperative pain over local infiltration in cesarian section.