Efficacy of Transversus Abdominis Plane (TAP) Block as Part of Multimodal Analgesia after Cesarean Section Delivery

Abstract

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 0.00(0.00-11.50) vs 39.00(7.75-60.50), p=0.001, at 4 hours 0.00(0.00–12.75) vs 17.50(13.25-24.00), p=0.000, at 6 hours 9.00(1.50- 12.00) vs 22.00(14.75-45.00), p=0.000, at 12hours 13.00(11.00-16.00) vs 42.00(10.00-52.00), p=0.003, at 24 hours 10.00(8.00-12.00) vs 15.50(11.25- 26.00), p=0.013 respectively. The total analgesic Tramadol consumption within 24 hours was reduced in TAP block group, and time for the first analgesic request was significantly prolonged (286.00 vs 76.25, p=0.000) minutes. Conclusion: Bilateral TAP block provides lower postoperative severity of pain, reduced total postoperative Tramadol analgesics consumption and prolonged time for the first analgesic request after cesarean section under spinal anesthesia when it is used as multimodal analgesia. We recommend TAP block should be included as part of multimodal analgesia in the postoperative period for women after Cesarean Section delivery