Multimodal Analgesia Transversus Abdominis Plane Block-Ketorolac Combination being Superior to Paracetamol-Ketorolac as Postoperative Pain Management after Cesarean Section in an Indonesian Hospital

Abstract

Aim: This study aimed to compare the outcome of multimodal analgesia using transversus abdominis plane block combined with ketorolac and multimodal analgesia oral paracetamol combined with ketorolac in postoperative pain after cesarean section. Background: Post-caesarean section pain resulted in prolonged recovery time, inhibited early breastfeeding initiation, and prolonged hospitalization. Multimodal analgesia is an important component of post-cesarean section pain management but has not been established in many Indonesian hospitals. Methods: This study was a retrospective, observational analytic study on 46 patients who received low-dose sub-arachnoid block anesthesia. A total of 24 subjects received bilateral transversus abdominis plane block employing ultrasonography-guided lateral approach, with Ropivacaine 0.25% in a total volume of 30cc combined with intravenous ketorolac 30 mg/8 h (Group B). A total of 22 subjects received oral paracetamol 500 mg/6 h combined with intravenous ketorolac 30 mg/8 h (Group A). Numeric Rating Scale (NRS), length of hospitalization, and mobilization time were analyzed using the T-test at a significance level of p<0.05 (confidence interval of 95%). Results: The NRS and mean time to start mobilization of patients who received transversus abdominis plane block combined with ketorolac were significantly better than patients who received paracetamol combined with ketorolac (p<0.05). There was no significant difference in the length of hospitalization between the two techniques (p>0.05). Both modalities resulted in improvement in pain intensity over the mild pain range. Conclusion: Multimodal analgesia transversus abdominis plane block combined with ketorolac is superior to paracetamol combined with ketorolac for postoperative pain management after cesarean section.