Evaluation of transversus abdominis plane block for postoperative analgesia after lower segment cesarean section

Background: Lower segment cesarean section (LSCS) is a common surgery in young women. There is a need for good postoperative analgesia in these cases as these patients are new mothers who need to nurse their newborns and there is a very important aspect of mother and child bonding for which they need to remain pain free and alert. For this, we need to rely on techniques which are not dependent on opioids and are equally effective. Transversus abdominis plane (TAP) block is one such technique which seems to fit the bill. This study was undertaken to evaluate the effectiveness of TAP block as a postoperative analgesia technique in these cases and its usefulness in reducing postoperative opioid consumption. Methods: One hundred and forty patients were selected prospectively who were to undergo LSCS. They were randomly divided into two groups: CONT and TAP. CONT group received subarachnoid block (SAB) with hyperbaric bupivacaine, and TAP group received similar SAB and immediately after surgery was given TAP block under ultrasound guidance with 20 ml of 0.25% bupivacaine with 4 mg dexamethasone on each side. Pain score was monitored in the postoperative period, every hour for 4 h and 2 hourly for next 4 h and then at 12, 18, 24, 36, and 48 h with visual analog scale of the scale 0 to 10. They all received intravenous paracetamol 1000 mg 8 hourly. If the pain score crossed four, they were given intramuscular (IM) diclofenac sodium 75 mg and if pain score persisted above four after an hour, they were given IM pethidine 50 mg. The time to requirement/demand of rescue analgesia was noted and a total amount of opioids given were noted. Results: The mean time to first analgesic rescue was significantly prolonged in Group TAP as compared to Group CONT using unpaired t-test. Mean time to rescue analgesia was 88.02 ± 21.62 min and 525.27 ± 114.52 min (P < 0.001) in groups CONT and TAP, respectively. Opioid consumption in Groups TAP and CONT was 14.29 mg versus 166.95 mg (P < 0.001) in 48 h. Conclusion: TAP block is a very effective modality for postoperative pain relief after LSCS. It helps in reducing opioid consumption and is likely to keep them more alert.