ANALGESIC EFFICACY AND OPIOID SPARING EFFECT OF TRANSVERSUS ABDOMINIS PLANE BLOCK AFTER CAESAREAN SECTION

Dr.J.Jayamurugavel; Dr.Rathesh Thangam

Volume : VII, Issue : III, March - 2018

ANALGESIC EFFICACY AND OPIOID SPARING EFFECT OF TRANSVERSUS ABDOMINIS PLANE BLOCK AFTER CAESAREAN SECTION

Dr. J. Jayamurugavel, Dr. Rathesh Thangam

Abstract :

A multimodal approach to postoperative analgesia after caesarean section is required. This study evaluates the efficacy of transversus abdominis plane (TAP) block in providing postoperative analgesia and opioid spå effect in caesarean section .

Aims and Objectives: The aim of the study was to evaluate the postoperative analgesic efficacy and opioid spå effect of transversus abdominis plane block after caesarean section.

Materials and methods: After obtaining approval from the Hospital Ethics Committee and written informed patient consent, a prospective, randomized, double blinded, case control study involving 50 ASA physical status I–II patients scheduled for caesarean section by pfannenstiel incision were included. Baselines data like pulse rate, blood pressure, respiratory rate, and basic investigations were collected. The patients were divided into two groups of 25 each, Group(R): Ropivacaine group and Group (N): Normal saline group. Patients were randomly allocated to undergo TAP block (n=25) with 20 ml of 0.375% ropivacaine (to a maximum dose of 150 mg) per side or TAP block with saline 0.9% (control n=25) Group (R) received 20 ml of 0.375% Ropivacaine on each side and Group (N) received 20 ml of normal saline on each side.The two groups were compared to evaluate efficacy and safety of TAP Block, evaluate pain scores at 1, 2, 3, 4, 5, 6, 12, 18, and 24 hrs after surgery, time of request of rescue analgesic and total postoperative opioid consumption. Groups were comparable in terms of age, weight and duration of surgery.

Results: The total tramadol consumption was less in R group (104±4.38mg) than in N group (324±26.15 mg) and difference was statistically significant, with p<0.05 likewise the mean time for first request of rescue analgesic was 290±20.94 minutes in R group, when compared with 81±1.79 minutes in the N group which is nearly 3½ times lesser than Ropivacaine group. The difference of 209 minutes with p<0.05 was statistically very significant and no complications due to the TAP block were detected.

Conclusion: Transversus abdominis plane (TAP) block as a component of multimodal analgesia provides highly effective postoperative analgesia in the first 24 hours after caesarean sections. As a component of multimodal analgesic regimen TAP block significantly reduced opioid consumption.