The Efficacy of Transverse Abdominal Plane Block with Bupivacaine Combined with Dexamethasone for the Management of Post-Caesarean Pain

Abstract

Introduction: Caesarean section (CS) is a commonly performed major surgical procedure that causes significant postoperative pain. The objective of this study was to evaluate the efficacy of the transverse abdominal plane block (TAPB) in the management of post-caesarean pain at the Souro Sanou Teaching Hospital (CHUSS) of Bobo Dioulasso. Methodology: This was a single blind randomised clinical trial. One hundred patients admitted for CS under spinal anaesthesia were randomised into two groups using the sealed envelope method. The intrathecal morphine (ITM) group received 100 µg morphine intrathecally at induction and the TAPB group a bilateral TAPB at the end of the caesarean section with 20 ml of 0.25% bupivacaine and 4 mg dexamethasone in the same syringe on each side. The proportion of mild pain, numeric rating scale (NRS) < 3 on mobilisation at 24 hours post-caesarean was the primary outcome. Results: The 2 groups were comparable for socio-demographic and clinical characteristics. The mean age of the patients was 28.14 ± 6.34 years and 29.08 ± 5.58 years (p=0.43). At rest at 24 hours post-op, the proportion of NRS < 3 was 100% for the TAPB group and 88% for the ITM group (p=0.49). On mobilisation at 24 hours post-op, 96% of patients in the TAPB group and 74% in the ITM group (p=0.002) had a NRS < 3. At rest at 48 hours post-op, it was 100% for the TAPB group and 88% for the ITM group (p=0.027). On mobilisation at 48 hours post-op, it was 94% for the TAPB group and 70% for the ITM group (p=0.002). Postoperative nausea and vomiting (PONV) were present in 50% of patients in the ITM group and 6% in the TAPB group (p<0.001). Conclusion: TAPB significantly reduced pain scores on mobilisation in the post-caesarean period with a significant reduction in PONV.