Transverse abdominis plane block as a method of anesthesia after caesarean section

Abstract

Although we have various methods of analgesia, the prevalence of severe pain after caesarean section remains high. Therefore, it is necessary to look for new reliable technologies for optimal postoperative anesthesia.The objective was to compare the efficiency of postoperative wound infiltration with a local anesthetic and transverse abdominis plane block (TAP-block) as a component of multimodal analgesia in the postoperative period after cesarean section.Materials and methods. A prospective randomized study was conducted. It included 91 patients after elective caesarean section under spinal anesthesia. Patients were divided into 3 groups depending on the method of postoperative analgesia. In group 1 (n = 30), we used wound analgesia. In group 2 (n = 32), transverse abdominis plane block was performed. In group 3 (n = 29), intravenous infusion of paracetamol in combination with intramuscular injection of tramadol 0.5 mg/kg were used for postoperative analgesia.Results. Pain syndrome was less severe after wound analgesia and TAP-block for 24 hours compared to analgesia with systemic analgesics. Moreover, during wound analgesia, lower points of the visual analogue scale (VAS) were traced for three days. The minimum consumption of paracetamol was on the background of wound analgesia, while no patient required the introduction of narcotic analgesics. Women in the wound analgesia group were able to earlier activating: they could walk after 5.6±0.2 hours, compared to 6.1± 0.2 hours with TAP-block and 8.8± 0.4 hours with analgesia with systemic analgesics.Conclusion. Continuous analgesia of postoperative wound is a safe and effective method that allows achieving adequate postoperative analgesia, avoiding using narcotic analgesics and reducing the consumption of non-narcotic systemic analgesics.