Guided Transversus Abdominis Plane Block Research Articles

Ultrasound-Guided Transversus Abdominis Plane (TAP) Block for Chronic Post-Operative Surgical Pain: Review of 20 Cases

Abstract Background: Post-operative surgical pain of at least 2- month duration in absence of clear causes was defined as Chronic Post-operative Surgical Pain syndrome (CPSP). Transversus Abdominis Plane (TAP) block is a new imple-mented regional anaesthetic technique included in the analgesic regimen for many abdominal surgeries to reduce immediate post-operative pain and opioid requirements. Aim of Study: To assess the feasibility and efficacy of US guided TAP block in the management of chronic post-operative surgical pain. Patients and Methods: US-guided TAB block done for 20 patients complaining of chronic lower abdominal pain around 3-months to one-year duration after surgical operation with injection of 20ml of bupivacaine 0.25% and 2ml of methyl prednisolone (40mg/ml). Unilateral injection done for 12 patients & bilateral injections done for 8 patients. Second injection done for 6 patients after 3 months (three unilateral & three bilateral). Patient's pain intensity was assessed by Visual Analogue Score (VAS) before procedure & during follow-up visits for the next six months. Results: Three months after US-guided TAP block; 5 patients with mild degree of pain & 2 out of 10 patients with moderate degree of pain became completely pain free, while other 13 patients acquired relative improvement (5 patients with mild degree of pain and 8 patients with moderate degree of pain). Six months after US-guided TAP block; 6 patients (accepted second injection) improved with mild degree of pain while other 2 patients showed little improvement with still moderate degree of pain. Conclusion: Ultrasound guided TAP block is safe and effective method in management of chronic post-operative surgical pain.

Comparative assessment of efficacy of various anesthesia options after cesarean section

The article describes the comparative assessment of efficacy of transversus abdominis plane block as a component of multimodal analgesia during cesarean section.Subjects and methods. 165 primiparous women were enrolled into the study, their average age made 30.5 years. Operative delivery was performed under spinal anesthesia. All patients were divided into five groups. In the patients in Groups 1 and 3, postoperative analgesia was performed using transversus abdominis plane (TAP) block without ultrasound guidance, while in Groups 2 and 4, TAP block was guided by ultrasound. In Groups 1 and 2, ropivacaine hydrochloride was used at a concentration of 0.2%, in Groups 3 and 4 - 0.375%. In Group 5, paracetamol in combination with narcotic analgesics was used for analgesia. Pain intensity was assessed every hour using a visual analogue pain scale at rest and during movement during the 1st day after delivery. To assess the severity of the stress response and metabolic status of patients, concentrations of cortisol, prolactin and glucose in blood plasma was tested. The levels of cortisol and prolactin were tested in 4 stages: before surgery, 1 hour after surgery, 6 and 24 hours after delivery. Plasma glucose was tested in 3 stages: before surgery, 1 hour and 6 hours after surgery.Results. TAP block in combination with paracetamol provided adequate postoperative analgesia, reduced the consumption of analgesics, and also contributed to the earliest activation of new mothers after cesarean section. The use of 0.2% ropivacaine hydrochloride solution with TAP block was equally effective as the use of 0.375% solution of ropivacaine hydrochloride. Ultrasound guided TAP block significantly improved the quality of postoperative pain management. TAP block reduced the level of stress hormones in patients but in 24 hours, the levels of stress hormones in all groups of patients receiving and not receiving TAP block did not differ.

Ultrasound-guided transversus abdominis plane block in high-risk infants, better option than opioids: A series of five cases

Perioperative analgesia poses specific problems, especially when it comes to neonates and infants. The use of opioid in neonates is usually associated with the risk of delayed extubation and postoperative mechanical ventilation. Regional analgesia including epidural and caudal may be technically challenging or has limitations in a certain group of patients. Ultrasound (US)-guided transversus abdominis plane block (TAP) is gaining popularity as a new technique of regional anesthesia applicable to infants and children. Precise drug administration is a major concern with TAP blocks in pediatric patients, especially infants and neonates. The application of US has enhanced the accuracy of local anesthetic deposition and hence the efficacy of analgesia in TAP block. We, hereby, report a series of five high-risk infants and neonates posted for abdominal surgeries wherein an ultrasonography-guided TAP resulted in satisfactory perioperative analgesia obviating the need of systemic opioids.

Postoperative analgesic efficacy of ketamine added to bupivacaine in ultrasound guided transversus abdominis plane block for laparoscopic cholecystectomy

Postoperative analgesic efficacy of ketamine added to bupivacaine in ultrasound guided transversus abdominis plane block for laparoscopic cholecystectomy

A randomized controlled trial to study the effect of hyaluronidase as adjuvant in ultrasound-guided transversus abdominis plane block for postoperative analgesia in total abdominal hysterectomy

Background: Transversus abdominis plane (TAP) block is a regional anesthesia technique for postoperative analgesia. Since multiple nerves are to be blocked in a single prick, mucolytic enzyme hyaluronidase is being used to improve the spread of the local anesthetic. The present study was conducted to evaluate the effect of adding hyaluronidase as an adjuvant to local anesthetic in ultrasound (US)-guided TAP block. Materials and Methods: Eighty patients were randomly divided into two groups, Group B and Group BH. Group B patients received US-guided bilateral TAP block with 38 ml of 0.25% bupivacaine (heavy) and 2 ml of NS. Group BH patients received 38 ml of 0.25% bupivacaine (heavy) with 3000 IU hyaluronidase (2 ml) after completion of surgery under spinal anesthesia. Visual analog score (VAS) and heart rate were noted periodically. Time of demand of the first rescue analgesia and total analgesic consumption in 24 h were noted. Patient satisfaction survey was done at the end of 24 h. Results: Group BH patients had lower mean VAS scores at 6 and 8 h postoperatively as compared to Group B. The mean time of demand for the first rescue analgesia was longer in Group BH (351 ± 16 min) as compared to Group B (307 ± 13 min). The cumulative dose of rescue analgesic needed was more in Group B (370 ± 9 min) as compared to Group BH (343 ± 8 min). Patient satisfaction score was 3.3 ± 0.5 in Group BH and 2.3 ± 0.5 in Group B. All the differences were statistically significant. Conclusion: Addition of hyaluronidase improved quality of postoperative analgesia which can be due to the enzymatic action of hyaluronidase which hydrolyses the hyaluronic acid in the connective tissue and facilitates the spread of local anesthetic solution.

Efficacy of ultrasound-guided transversus abdominis plane block in breast reconstruction surgery with abdominal myocutaneous flap

Background: Ultrasound (US)-guided transversus abdominis plane block (TAPB) provides postoperative analgesic efficacy in abdominal surgery, however evidence of its efficacy in reconstructive breast surgery with transversus rectus abdominis myocutaneous (TRAM) flap is still limited. Our main objective was to assess effectiveness of TAPB in this surgery. Methods: Observational retrospective study conducted in patients undergoing unilateral breast reconstruction with TRAM (surgery 1) and mastectomy (partial or total) followed by TRAM reconstruction (surgery 2) from April 2015 to June 2017. Two anaesthetic plans were analysed: general balanced anaesthesia (GBA) and combined GBA with bilateral TAPB (GBA+TAPB). Primary outcomes were total intraoperative administered fentanyl, total consumed morphine in postoperative anaesthesia care unit (PACU) and time between conclusion of surgery and first requested analgesic (analgesia time). Results: 107 patients were included: 80 submitted to surgery 1 and 27 submitted to surgery 2. In surgery 1, intraoperative fentanyl consumption and administered morphine, during the patients’ stay at PACU, were lower in GBA+TAPB than in GBA group (p Regarding surgery 2, globally no significant differences were identified between both groups. No complications associated to local anaesthetics or TAPB were registered. Conclusion: US-guided bilateral TAPB resulted in lower opioid consumption and better pain control in unilateral breast reconstruction surgery with TRAM.

Effect of addition of buprenorphine or dexamethasone to levobupivacaine on postoperative analgesia in ultrasound guided transversus abdominis plane block in patients undergoing unilateral inguinal hernia repair: a prospective randomized double blind controlled trial.

BackgroundThe transversus abdominis plane (TAP) block is an effective technique to block the thoracolumbar nerves innervating the anterolateral abdominal wall. This study was conducted to evaluate the analgesic efficacy and opioid consumption with the use of perineural buprenorphine or dexamethasone in TAP blocks after unilateral inguinal hernioplasties.MethodsThis prospective, randomized, double-blinded, placebo-controlled study enrolled 93 patients scheduled for unilateral inguinal hernioplasty, followed by an ultrasound-guided TAP block. The participants were randomized into 3 groups (31 patients each). Group L received 20 ml 0.25% levobupivacaine + 1 ml normal saline (NS); group LB, 20 ml 0.25% levobupivacaine + 0.3 mg (1 ml) buprenorphine; and group LD, 20 ml 0.25% levobupivacaine + 4 mg (1 ml) dexamethasone. The patients were observed postoperatively for 24 h for first rescue analgesic requirement, total rescue analgesic consumption, and pain scores on the numeric rating scale (NRS).ResultsThe time to first rescue analgesic requirement was significantly longer in Group LB than in groups LD and L (688.87 ± 36.11 min, 601.45 ± 39.85 min, and 383.06 ± 36.21 min, respectively; P < 0.001). The mean total tramadol consumption in the first 24 h was the lowest in group LB (P < 0.001, L vs. LB / LD). Groups LB and LD displayed significantly lower NRS scores than group L (P < 0.001 both).ConclusionsLevobupivacaine with perineural buprenorphine in a TAP block after unilateral open inguinal hernioplasty facilitates prolonged analgesia and reduced requirement for rescue analgesics compared to perineural dexamethasone, without significant side effects.

Effect of dexamethasone as an adjuvant to ropivacaine on duration and quality of analgesia in ultrasound-guided transversus abdominis plane block in patients undergoing lower segment cesarean section - A prospective, randomised, single-blinded study.

Background and Aims:Ultrasound guided transversus abdominis plane block is an efficacious abdominal field block. The aim was to determine the effect of dexamethasone to 0.375% ropivacaine on the analgesic duration of TAP block in patients undergoing lower segment cesarean section (LSCS).Methods:A single-blinded randomised control study was conducted on 90 patients, who were divided in two groups of 45 each. Group R received 0.375% ropivacaine (25 ml) with normal saline (1 ml) each side and group D received 0.375% ropivacaine (25 ml) with dexamethasone 4 mg (1 ml) each side in transversus abdominis plane block after lower segment cesarean section. Primary objective was to compare time to first rescue analgesia and secondary objectives to compare the total amount of analgesia required in first 24 h postoperatively, visual analog scale scores for somatic and visceral pain and incidence of nausea and vomiting, between the two groups. Student's t test, Chi-square, or Fisher's exact test were performed using SPSS 17.0.Results:Time to first rescue analgesia was significantly less in group R (11.62 ± 3.80 h) compared to group D (19.04 ± 4.13 h) (P < 0.001). Total tramadol consumed in 24 h was significantly higher in group R (86.67 ± 30.55 mg) than group D (35.56 ± 39.54 mg) (P < 0.001). Visual analog scale scores for both somatic and visceral pain were significantly higher in group R than group D at 8 h, 12 h, and 24 h postoperatively.Conclusion:Addition of dexamethasone to ropivacaine in transversus abdominis plane block significantly prolongs the duration of postoperative analgesia.

Comparative study of ropivacaine with dexmedetomidine versus ropivacaine in ultrasound guided transversus abdominis plane block for post-operative pain relief in cesarean section

Comparative study of ropivacaine with dexmedetomidine versus ropivacaine in ultrasound guided transversus abdominis plane block for post-operative pain relief in cesarean section

A Comparative Study of Pre-operative and Post-operative Approaches to Ultrasound Guided Transversus Abdominis Plane Block for Post-operative Analgesia in Patients Undergoing Total Abdominal Hysterectomy

A Comparative Study of Pre-operative and Post-operative Approaches to Ultrasound Guided Transversus Abdominis Plane Block for Post-operative Analgesia in Patients Undergoing Total Abdominal Hysterectomy

Evaluation of Ultrasound Guided Transversus Abdominis Plane Block for Post Operative Analgesia after Lower Segment Caeseraen Section

Evaluation of Ultrasound Guided Transversus Abdominis Plane Block for Post Operative Analgesia after Lower Segment Caeseraen Section

Transversus abdominis plane block under laparoscopic guide versus port-site local anaesthetic infiltration in laparoscopic excision of endometriosis: a double-blind randomised placebo-controlled trial.

To compare the efficiency of laparoscopically guided transversus abdominis plane block (LTAP) versus port-site local anaesthetic infiltration (LAI) in reducing postoperative pain following laparoscopic excision of endometriosis. A prospective, double-blind randomised controlled trial. A tertiary referral centre for endometriosis and minimally invasive gynaecological surgery. Women undergoing laparoscopic excision of endometriosis from December 2015 through July 2016. Participants were randomised to receive: port-site infiltration with bupivacaine and placebo LTAP (LAI group, n=21); placebo port-site infiltration and LTAP with bupivacaine (LTAP group, n=24); placebo port-site infiltration and placebo LTAP (placebo group, n=25). Post-operative pain at 2-4, 6-8, 10-12 and 24hours, analgesic requirements, TAP block-related complications and opioid-related adverse effects. There were no differences in patient characteristics between the groups. In comparison with placebo, both LTAP and LAI groups had significantly less pain at 2-4, 6-8, and 10-12hours (median 3, 3, 3.5 versus 3, 6, 4 versus 8, 8, 7 for LTAP, LAI, and placebo, respectively, P<0.05). Median differences (and 95% confidence intervals) were as follows; LTAP versus placebo -5 (-6 to -4), -4 (-5 to -3), -3 (-4 to -0.5); LAI versus placebo -4 (-5 to -2), -2 (-3 to -0.5), -1 (-4 to -0.5) at 2-4, 6-8 and 10-12hours, respectively. There were no statistically significant differences between the LTAP and LAI groups. Laparoscopically guided transversus abdominis plane block and LAI both reduce postoperative pain in patients undergoing laparoscopic excision of endometriosis, compared with placebo. We found no differences in effect between LTAP and LAI. TAP block and port-site local infiltration are both effective in reducing postoperative pain in major gynaecological laparoscopic surgery.

Effect of ultrasound-guided transverses abdominis plane block on analgesic efficacy of patients undergoing colon cancer radical surgery

Objective To evaluate the postoperative analgesic efficacy of transversus abdominis plane (TAP) block in patients undergoing colon cancer radical surgery. Methods There were 96 patients who underwent colon cancer radical surgery, with no gender restriction and USA society of anesthesiologists score standard (ASA) grade Ⅰ-Ⅲ. They were randomly divided into 2 groups: control group (C group C) and observation group (TAP group). The control group was only given routine general anesthesia, while the observation group was treated with ultrasound guided TAPB on the basis of the control group. The changes of mean arterial pressure, surgical pleth index, heart rate, entropy index, inhaled sevoflurance concentration and sufentanil in the two groups were observed at the baseline (T1), skin incision (T2), 5 min after skin incision (T3), 30 min after skin incision (T4), and sewn skin (T5). At four postoperative time points: 30 min(T6) after extubation, postoperative 6 h (T7), postoperative 24 h (T8), postoperative 48 h (T9), the Internet of things plus-wireless analgesia system automatically recorded postoperative dosage of patient controlled intravenous analgesia (PCIA) sufentanil and postoperative analgesic efficacy was followed up blindnessly by a specially-assigned person. Results As compared with C group, at T3 (0.64±0.11) vs. (0.71±0.12) μg/kg, T4 (0.66±0.15) vs. (0.81±0.15) μg/kg, T5 (0.70±0.12) vs. (0.93±0.15) μg/kg, T6 (0.99±0.12) vs. (1.07±0.19) μg/kg, T7 (1.35±0.20) vs. (1.49±0.16) μg/kg, T8 (2.00±0.42) vs. (2.25±0.31) μg/kg, T9 (2.67±0.50) vs. (3.27±0.47) μg/kg, dosages of sufentanil in TAP patients decreased (P=0.006, 0.000, 0.000, 0.027, 0.001, 0.002, 0.000), and the patients for deficiency of analgesia decreased from 17 cases to 8 at T8 (χ2=4.381, P=0.036). Conclusion Ultrasound guided TAP block combined with general anesthesia can improve the analgesic efficacy intraoperatively and postoperatively in radical resection of colon cancer. Key words: Ultrasonic guidance; Transverses abdominis plane; Colon cancer surgery; Patient controlled intravenous analgesia

Application of ultrasound guided transversus abdominis plane block in the perioperative analgesia

Comfort medical treatment has aroused the attention of all walks of life. Perioperative analgesia will be one of the important components. The analgesic guidelines of American Society of Anesthesiologists (ASA) and anesthesiology are all advocating multi mode analgesia. Transversus abdominis plane (TAP) block is considered to be one of the effective methods of multimode analgesia in the perioperative period. It can provide analgesia for surgical perioperative period, reduce the dosage of opioid after operation and the incidence of adverse reactions. We review the relevant factors on patient selection, anesthetic seletion and clinical efficacy for TAP block by reviewed relative literatures, aiming to provide new methods and ideas for clinical practice. TAP block opens new ideas for perioperative analgesia, and it is a new direction of multimode analgesia during perioperative period. Key words: Ultrasonography; Nerve block; Abdominal muscles; Analgesia; Review

Comparison of Ultrasound Guided Transversus Abdominis Plane Block versus Local Wound Infiltration for Post Operative Analgesia in Patients Undergoing Inguinal Hernia or Infra Umbilical Incisional Hernia

Background: since the concept of day case surgeries are getting more popular, surgeons and anesthesiologists are trying their best to provide adequate post operative analgesia. The proper management of post operative pain ensures early ambulation of patients and obviates many postoperative complications. Aim of the Work: to compare the efficacy of transversus abdominis plane (TAP) block versus wound infiltration with local anesthetic agent as regarding postoperative analgesia, its effect on hemodynamic changes (HR, BP) during rest, opioid (pethidine) consumption. The patients included in this study were either of inguinal hernia or infra umbilical incisional hernia. Patients and Methods: after obtaining approval from the medical ethical committee in Ain Shams University, this prospective randomized clinical trial study was conducted in Ain Shams University Hospital. It included fifty adult undergoing inguinal hernia or infra umbilical incisional hernia repair. Results: patients were assigned randomly into two equal groups: Group A: (n = 25) TAP Block: patients received general anesthesia followed by Tap block at the end of the operation. Group B: (n=25) Local Wound Infiltration: patients received general anesthesia followed by local wound infiltration at the end of the operation. Conclusion: bilateral TAP block was effective in reducing postoperative pain scores at rest and movement for 8-12 hours and lower total 24-h postoperative opioid and analgesic consumption after inguinal hernia or infra umbilical incisional hernia repair under general anesthesia, compared to local wound infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.

Comparison of Ultrasound Guided Transversus Abdominis Plane Block versus Local Wound Infiltration for Post Operative Analgesia in Patients Undergoing Inguinal Hernia or Infra Umbilical Incisional Hernia

Background: since the concept of day case surgeries are getting more popular, surgeons and anesthesiologists are trying their best to provide adequate post operative analgesia. The proper management of post operative pain ensures early ambulation of patients and obviates many postoperative complications. Aim of the Work: to compare the efficacy of transversus abdominis plane (TAP) block versus wound infiltration with local anesthetic agent as regarding postoperative analgesia, its effect on hemodynamic changes (HR, BP) during rest, opioid (pethidine) consumption. The patients included in this study were either of inguinal hernia or infra umbilical incisional hernia. Patients and Methods: after obtaining approval from the medical ethical committee in Ain Shams University, this prospective randomized clinical trial study was conducted in Ain Shams University Hospital. It included fifty adult undergoing inguinal hernia or infra umbilical incisional hernia repair. Results: patients were assigned randomly into two equal groups: Group A: (n = 25) TAP Block: patients received general anesthesia followed by Tap block at the end of the operation. Group B: (n=25) Local Wound Infiltration: patients received general anesthesia followed by local wound infiltration at the end of the operation. Conclusion: bilateral TAP block was effective in reducing postoperative pain scores at rest and movement for 8-12 hours and lower total 24-h postoperative opioid and analgesic consumption after inguinal hernia or infra umbilical incisional hernia repair under general anesthesia, compared to local wound infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.

Effect of Using Dexmedetomidine with Ultrasound Guided Transversus Abdominis Plane Block on Postoperative Stress Response in Abdominal and Pelvic Surgeries: Comparative Study

Effect of Using Dexmedetomidine with Ultrasound Guided Transversus Abdominis Plane Block on Postoperative Stress Response in Abdominal and Pelvic Surgeries: Comparative Study

Comparative Study between Bupivacaine versus Bupivacaine with Dexmeditomidine in Ultrasound Guided Transversus Abdominis Plane Block for Postoperative Analgesia in Cancer Patients Undergoing Major Pelviabdominal Surgeries

Abstract Background: The main contributor to the pain experienced after abdominal surgery is pain from the incision made in the abdominal wall. The Transversus Abdominis Plane (TAP) block is a peripheral nerve block to the nerves supplying the anterior abdominal wall (T6 to L1). The aim of this study was to evaluate the effect of dexmedetomidine as an adjuvant in ultrasound guided TAP block on post-operative analgesia and morphine consumption in patients undergoing major abdominal or pelvic surgeries.Methods: Seventy five patients were randomly enrolled in the study; patients were divided into 3 groups: Bupivacaine group (group TAP, n=25) received TAP block with bupivacaine done after skin closure, bupivacaine with dexmedetomidine group (group TAP + Dex, n=25) received TAP block with dexmedetomidine added to the bupivacaine and intravenous dexmedetomidine group (group TAP + IV-Dex) received TAP block with bupivacaine in addition to intravenous dexmedeto-midine. Results: The mean time to the first rescue analgesic requirement was significantly longer in both group TAP + Dex (9.8±2.9) hours and group TAP + IV-Dex (10.0±2.3) hours than in group TAP (5.7±1.6) hours (p<0.001). Total morphine consumption in the first 24 hours post-operatively was significantly higher in group TAP (24.3±3.6) mg than in both group TAP + Dex (11 .8±3.7) mg and group TAP + IV-Dex (11.8±3.6) mg (p<0.001). Post-operative VAS pain score was higher in group TAP than in group TAP + IV-Dex at 6 and 12 hours but all three groups were comparable at 2, 4 and 24 hours. Patient satisfaction score was significantly lower for group TAP in comparison to the other two groups (p< 0.001).Conclusion: Dexmedetomidine whether added to bupi-vacaine in the TAP block or administered intravenously improved postoperative analgesia with lower total morphine consumption in the first 24 hours post-operative as a part of multimodal analgesia in abdominal and pelvic surgeries.

Role of ultrasound guided transversus abdominis plane block as a component of multimodal analgesic regimen for lower segment caesarean section: a randomized double blind clinical study

BackgroundWhile opioids are the mainstay for post-operative analgesia after lower segment caesarean section, they are associated with various untoward effects. Ultrasound guided transversus abdominis plane (TAP) block has been postulated to provide effective analgesia for caesarean section. We evaluated the analgesic efficacy of this block for post caesarean analgesia in a randomised controlled trial.MethodsOne hundred thirty-nine mothers undergoing caesarean delivery were randomised to receive TAP block with either 20 ml 0.375% ropivacaine or 20 ml saline after obtaining informed consent. All the subjects received a standard spinal anaesthetic and diclofenac was administered for post-operative pain. Breakthrough pain was treated with tramadol. Post-operatively, all the subjects were assessed at 0, 2, 4, 6, 8, 10, 12, 18 & 24 h. The primary outcome was the time to first analgesic request. The secondary measures of outcome were pain, nausea, sedation, number of doses of tramadol administered and satisfaction with the pain management.ResultsThe median (interquartile range) time to first analgesic request was prolonged in the TAP group compared to the control group (p < 0.0001); 11 h (8,12) and 4 h (2.5,6) respectively. The median (interquartile range) number of doses of tramadol consumed in the TAP group was 0 (0,1) compared to 2 (1,2) in the control group (p < 0.0001). At all points in the study, pain scores both at rest and on movement were lower in the study group (p < 0.0001). Maternal satisfaction with pain relief was also higher in the study group (p 0.0002). One subject in the TAP group had convulsions following injection of local anaesthetic solution. She was managed conservatively with supportive treatment following which she recovered.ConclusionTAP block reduces pain, prolongs the duration of analgesia and decreases supplemental opioid consumption when used for multimodal analgesia for pain relief after caesarean section. However, the risk of local anaesthetic systemic toxicity remains unknown with this block. Hence larger safety trials and measures to limit this complication need to be ascertained.Trial registrationThe trial was registered with the Clinical Trial Registry of India (CTRI/2017/03/008194) on 23/03/2017 (trial registered retrospectively).

Ultrasound Guided Transversus Abdominis Plane Block versus Intrathecal Nalbuphine Injection for Postoperative Analgesia in Preeclamptic Patients Undergoing Cesarean Section

Ultrasound Guided Transversus Abdominis Plane Block versus Intrathecal Nalbuphine Injection for Postoperative Analgesia in Preeclamptic Patients Undergoing Cesarean Section