Comparison of bilateral transversus abdominis plane block and wound infiltration with bupivacaine for postoperative analgesia after cesarean delivery.

Ümit Görkem,Cihan Toğrul,Kamuran Koçyiğit,Tayfun Güngör

doi:10.4274/jtgga.2016.0155

Abstract

Objective:The study aimed to compare efficacy, safety, pain intensity and analgesic consumption in patients receiving either bilateral transversus abdominis plane (TAP) block or wound infiltration with bupivacaine after cesarean delivery (CD).Material and Methods:A total of 216 parturient women undergoing CD under general anesthesia were randomly allocated into five groups: i) controls (group 1), ii) TAP placebo (group 2), iii) TAP (group 3), iv) wound infiltration placebo (group 4), and, v) wound infiltration (group 5). Pain intensity was assessed using a visual analogue scale (VAS). Analgesic consumptions were recorded by a blinded nurse at 6, 12, and 18 hours postoperatively.Results:The baseline characteristics of the five groups were similar in terms of age, history of CD, and body mass indices (p>0.05). There were significant intergroup differences in VAS scores between all groups at the zero time-point (p=0.03), at the 6th hour (p=0.02), 12th hour (p=0.02), and at the 18th hour (p=0.02). Group 3 patients had lower pain scores and consumed less diclofenac than group 2 patients only within 12 hours postoperatively whereas pain intensity and analgesic consumption were not different between group 5 and group 4 patients. Group 5 patients received significantly less pethidine than group 4 and group 1 patients (p<0.001).Conclusion:TAP block provided better pain relief and less analgesic requirement than bupivacaine wound infiltration early after CD. Given the similar amounts of diclofenac but lower amounts of pethidine administered in the wound infiltration group, wound infiltration of bupivacaine seems promising in terms of reducing opioid use after CD under general anesthesia, especially when TAP block is not used.

Highlights

Cesarean delivery (CD) rates have been substantially rising worldwide and Turkey is among the countries where the increasing trend is most prominent [1]
Our study showed that a single injection Transversus abdominis plane (TAP) block satisfactorily provided pain relief for 12 hours postoperatively in patients who underwent elective CD under general anesthesia whereas such benefit was limited in patients who received wound infiltration with local anesthetic at similar doses
The difference in visual analogue scale (VAS) scores observed between TAP block and TAP placebo patients sustained until the 12th hour assessment patients in the TAP placebo group received much more diclofenac and pethidine

Summary

Introduction

Cesarean delivery (CD) rates have been substantially rising worldwide and Turkey is among the countries where the increasing trend is most prominent [1]. The number of women showing a tendency to have CD is rising possibly because this type of delivery sounds less frightening and less painful than normal vaginal birth. CD has become an appealing option requested by women in the general population and by health care providers, owing to the concerns commonly raised about complications and pain experience during labor [2]. Post-operative pain, which appears after elimination of the anesthesia, continues for days after surgery and still constitutes a major problem in patients receiving CD [3]. It was reported that about 10% of women still experience substantial pain after CD even though a programmed analgesic regimen was implemented [4]. Women with depressive symptoms during the postnatal period report pain more commonly than those without depression [5]. Transversus abdominis plane (TAP) block has gained popularity among physicians owing to the ease of the procedure and its

Methods

Results

Conclusion