Abstract
BackgroundWomen's pain satisfaction post-cesarean section remains a challenge. Accurate assessment of pain severity of post-cesarean section helps to choose the most appropriate anesthetic approach, drug, and dose, as well as improvement of treatment of postoperative pain. Our objective was to compare the efficacy of ultrasound-assisted transversus abdominis plane (TAP) block versus IV patient-controlled analgesia (PCA) in the first 24 h postoperative in women who underwent cesarean section. The primary outcome was postoperative pain at 2, 4, 6, 12, and 24 h. The secondary outcomes were intestinal mobility, early mobilization, nausea, vomiting, heart rate, and respiratory rate.ResultsA cross-sectional study has been conducted on 70 women who are planned for elective cesarean section. They were divided into 2 groups; “group A” (n = 35), women who received TAP block, and “group B” (n = 35), those who received PCA. Pain score, heart rate, respiratory rate, intestinal motility, nausea, and vomiting have been assessed 2, 4, 6, 12, and 24 h postoperatively. The degree of pain was significantly lower in “group B” than in “group A” in all time intervals (p < 0.001). Heart rate was significantly higher in women in “group B” compared to those in “group A” only at 2 and 4 h postoperative (p < 0.001). Nausea and vomiting were also significantly higher in women in “group B” compared to those in “group A” (p value 0.03 and 0.04, respectively). Regarding intestinal motility, it was audible in “group A” earlier than in “group B.”ConclusionsBoth TAP block and PCA are effective in postoperative pain relief after cesarean section; however, PCA is more superior, especially for visceral pain. Nevertheless, TAP block has the privilege of avoiding systemic action of opioids used in PCA. PCA can easily be applied while TAP block needs more training and an intraoperative ultrasound machine. Complications and side effects of both were minimal when adjusting the doses.
Highlights
Women’s pain satisfaction post-cesarean section remains a challenge
Pearson chi-square test was used for qualitative data between both groups; Values are expressed as number and percentage group “group B” than in the transversus abdominis plane (TAP) block group “group A” (p < 0.001) (Table 2)
Heart rate was significantly higher in women in “group B” compared to those in “group A” at 2 and 4 h postoperatively (p < 0.001); there is no significant difference between both groups in other time periods (p > 0.05)
Summary
Accurate assessment of pain severity of post-cesarean section helps to choose the most appropriate anesthetic approach, drug, and dose, as well as improvement of treatment of postoperative pain. Recent literature has reported that worldwide, including Egypt, there has been a dramatic surge in the cesarean delivery rate (Mobarak and Sultan 2019). Such surge is accompanied by increased women’s awareness and demands for pain-free techniques during and after the surgery. This motivates obstetricians to use new approaches and methodologies rather than the routine. Using opioids throughout different routes is still the gold standard (Taneja et al 2017)
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