Ultrasound-guided bilateral transversus abdominis plane block versus conventional systemic analgesia after cesarean section

Abstract

Goal The aim of this study was to test whether the ultrasound (US)-guided continuous transversus abdominis plane (TAP) block, as a part of a multimodal analgesic regimen, would result in decreasing systemic analgesic consumption and improving analgesia in the first 24 h after cesarean section in comparison with conventional systemic analgesia. Patients and methods Sixty-two healthy parturients scheduled for elective cesarean delivery under general anesthesia were included in this double-blinded randomized prospective study. Participants were randomly assigned into one of two groups. In the TAP group ( n = 31), TAP catheter was inserted bilaterally immediately after completing the surgery and before recovery from general anesthesia under US guidance. Bupivacaine (0.25%) 15 ml was then injected on each side and then every 6 h for the first 24 h. In the systemic analgesia group (Sys group; n = 31), patients received intravenous ketolac (20 mg) before recovery to be repeated every 8 h. The assessment of both groups was performed at 1, 2, 4, 6, 12, and 24 h postoperatively. The assessment included heart rate and blood pressure, visual analog score at rest and during movement, frequency of giving paracetamol to patients, and total morphine requirement throughout the 24 h. Salivary α-amylase was measured 4 h postoperatively. Complications were also recorded. Results The TAP group showed significantly lower visual analog score at rest and during movement. A significantly higher percentage of patients among the systemic analgesia group required more rescue paracetamol analgesia than those in the TAP group. The total morphine consumption in 24 h was highly significantly greater in the systemic analgesia group. Salivary α-amylase showed significant increase in the systemic analgesia group in comparison with the TAP group. Conclusion US-guided continuous TAP block decreased systemic analgesic consumption and improved analgesia in the first 24 h after cesarean section. US-guided continuous TAP block is recommended to be incorporated to the multimodal analgesia protocol.