Prospective randomized study comparing transversus abdominus plane block and spinal fentanyl added to bupivacaine for postoperative analgesia after cesarean section

Abstract

Background Cesarean section is a very common surgery and so postoperative pain in cesarean section is a major problem; different modalities of analgesia exist. Transversus abdominus plane (TAP) block is a simple and safe technique and can be used for postoperative analgesia after lower abdominal surgeries. Aim The aim of this study was to compare between postoperative analgesic effect of TAP block and spinal fentanyl added to bupivacaine in patients undergoing cesarean section. Participants and methods This study was carried out on 80 pregnant women presented for elective cesarean section who met the American Society of Anesthesiology II status. The patients were randomized into two equal groups (40 patients in each group). − Group I (spinal fentanyl group): patients received intrathecal 2.5 ml heavy bupivacaine 0.5% plus 25 µg fentanyl. Group II (TAP block group): patients received intrathecal 2.5 ml heavy bupivacaine 0.5% and then TAP block with 40 ml bupivacaine 0.25% (20 ml each side). Heart rate and mean arterial blood pressure were recorded postoperatively; postoperative pain was assisted by visual analog scale (VAS) score, time of postoperative first rescue analgesia, and total amount of rescue analgesia consumption. Results As regards hemodynamics (heart rate and mean arterial blood pressure) there was significant difference between both groups; at 2 h in group II it was lower than group I. Comparison of VAS score among both groups have shown that there was significant difference at 2 h as group II showed extended postoperative analgesia as the VAS score started to elevate at 6 h. Time of first rescue analgesia was significantly shorter in group I than in group II. Pethidine consumption was significantly lower in group II than in group I. Conclusion TAP block is a simple and safe technique and may be a potential alterative to spinal opioid for analgesia after cesarean section with no or minimal effects on hemodynamics, more prolonged analgesia, and less pethidine consumption and no or minimal complications.