Enhanced recovery after surgery (ERAS) protocol with multimodal analgesia incorporating transverse abdominis plane block after elective caesarean delivery: A randomised controlled trial

Abstract

Objective

To evaluate ERAS protocol with multimodal analgesia incorporating transverse abdominis plane(TAP) block compared to routine postoperative care for pain control in women undergoing elective caesarean delivery.

Methods

This randomized study was conducted after ethical approval and CTRI registration (2020/10/028652). Total 140 women scheduled for elective caesarean were randomised into two groups. ERAS protocol was implemented in Group-1(n=70), and routine practice was followed in Group-2(n=70). Multimodal analgesia included TAP block after skin closure and intravenous paracetamol at shifting to recovery, followed by oral drugs as per analgesic clock. Outcomes were Pain Numerical Rating Scale(NRS) at rest and on movement at 6, 12, 24, 48 hours and at readiness for discharge, and need for rescue analgesics.

Results

NRS was significantly less in group-1 at all time points at rest and movement. Mean±SD NRS at rest was 30.57±1.52 vs. 64.71±1.52 at 6 hours, 28.14±1.39 vs. 56.57±1.39 at 12 hours in group-1 vs. group-2 respectively; (P=0.001). NRS on mobilisation was 37.71±1.57 vs. 74.00±1.57 and 36.42±1.46 vs. 65.28±1.46 at 6 and 12 hours respectively, (P=0.001). Patients needing rescue analgesia were 30 % vs. 87.1 % within 6 hours(65 % reduction), in 24.3 % vs. 77.1 % between 6–12 hours, 4.3 % vs. 40 % between 12–24 hours in group-1 and 2 respectively; with no requirement after 48 hours in either group. The mean Likert score for satisfaction was 4.4±0.60 and 3.4±0.78 in group-1 and group-2, respectively, p<0.001.

Conclusion

ERAS protocol incorporating TAP block was effective in reducing postoperative pain, with 65 % reduction in requirement of rescue analgesia within six hours.