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.

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Effectiveness of Transversus Abdominis Plane Block for Postoperative Analgesia in Obstetric Cases Undergoing Caesarean Section

Birat Journal of Health Sciences ◽

10.3126/bjhs.v4i2.25460 ◽

2019 ◽

Vol 4 (2) ◽

pp. 755-758

Author(s):

Roshan Pradhan ◽

Seema Kumari Mishra ◽

Lalit Kumar Rajbanshi ◽

Kanak Khanal ◽

Batsalya Arjyal ◽

...

Keyword(s):

Caesarean Section ◽

Pain Score ◽

Postoperative Analgesia ◽

Transversus Abdominis ◽

Control Group ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Rescue Analgesia ◽

Visual Analogue Pain ◽

Significant Difference

Introduction: Transversus abdominis plane (TAP) block is a regional anesthesia that involves the infiltration of local anesthetic in between the internal oblique and transversus abdominis muscle plane. This block provides post-operative analgesia and reduces the requirement of opioids consumption. Objective: To assess the effectiveness of TAP block in providing postoperative analgesia in women undergoing caesarean section. Methodology: This was a hospital based prospective, comparative, cross sectional study conducted in 70 patients from 17th September 2018 to 17th February 2019 undergoing caesarean section under spinal anesthesia. Patients were divided into two groups. Group A patients received TAP block with 0.5% Ropivacaine versus Group B patients received injection paracetamol 1gm intravenous every 8 hourly as a standard and routine analgesic. At the end of the surgery, TAP block was performed by anesthesiologist and assessment of postoperative pain using a visual analogue pain score at every 1 hour, 3 hour, 6 hour, 12 hour and 24 hour by trained staffs at postoperative ward. Then, depending upon the severity of the pain injection fentanyl 1mcg/kg intravenous was given as rescue analgesia. Short assessment of patient satisfaction (SAPS) score was also assessed 24 hours postoperatively. Results: Compared to control group, in women who received TAP block, there was statistically significant reduction in pain at 3 hr, 6 hr, 24 hrs. However at 12 hrs there was no significant difference in the pain score. The cumulative fentanyl requirement was also significantly less in the TAP block group at all the time points. Conclusion: The TAP block provided highly effective postoperative analgesia following caesarean section and reduces the fentanyl requirement in the first 24 hour.

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A Comparative Study between Analgesic Efficacy of Intrathecal Buprenorphine and USG-Guided Transversus Abdominis Plane Block in Patients Undergoing Cesarean Section under Spinal Anesthesia

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0041-1740055 ◽

2021 ◽

Author(s):

Rajashree Deelip Godbole ◽

Abhilash Bandari ◽

Jasmeet Gill ◽

Shruti Tolambia ◽

Yuvraj Hake ◽

...

Keyword(s):

Cesarean Section ◽

Postoperative Analgesia ◽

Analgesic Efficacy ◽

Transversus Abdominis ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Hyperbaric Bupivacaine ◽

Rescue Analgesia ◽

Group A ◽

Group B

Abstract Objective The aim of this study was to evaluate and compare the postoperative analgesic efficacy of intrathecal buprenorphine with ultrasonography (USG)-guided transversus abdominis plane (TAP) block in patients of cesarean section. Materials and Methods: Sixty American Society of Anesthesiologists grade I and II pregnant women aged between 20 and 40 years requiring lower segment cesarean section were included in this study. Study Design A prospective randomized comparative study. Study Groups Group A received intrathecal hyperbaric bupivacaine 0.5% 1.8 mL with 60 µg buprenorphine. Group B received intrathecal hyperbaric bupivacaine 0.5% 1.8 mL with 0.2 mL sterile normal saline and at the end of surgery USG-guided bilateral TAP block was given with 20 mL 0.25% bupivacaine on each side of abdomen. Results The mean ± standard deviation of time to first rescue analgesia in Group A and group B was 9.17 ± 0.64 hours and 5.59 ± 0.50 hours, respectively. Distribution of mean time to first rescue analgesia among the cases studied is significantly higher in group A compared with group B. The distribution of paracetamol and tramadol requirement in first 24 hours among the cases studied was significantly higher in group B compared with group A. Conclusion The addition of buprenorphine to intrathecal hyperbaric bupivacaine has advantages over USG-guided TAP block for postoperative analgesia after cesarean section—longer duration of postoperative analgesia, lower analgesic requirements over first 24 hours, and cost–effectiveness.

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