THE SAFETY AND EFFECTIVENESS OF INTRAOPERATIVE TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK IN REDUCING PAIN AFTER CESAREAN DELIVERY: A RANDOMIZED CONTROLLED STUDY
Aimy Essam, Ahmed H. Attia
Department of Obstetrics &Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
Objective: The aim of the current study was to evaluate the safety and efficacy of intraoperative transversus abdominis plane (TAP) block performed after uterine closure in cesarean delivery in reducing the severity of pain at rest and at movement compared to placebo. Study Design: A prospective randomized double blinded placebo-controlled clinical trial. Patients and Methods: The study was conducted in obstetrics and gynecology hospital, faculty of medicine, Cairo University, Egypt in the period from April 2016 till December 2016. We included 200 women undergoing or scheduled for cesarean delivery. Patients were randomly allocated in one of two groups: group I who received TAP block with 20 ml of 0.25% bupivacaine intraoperatively and group II in whom 20 ml of saline as a placebo was applied. The primary outcome was mean pain score at 6 hours postoperatively at rest using 100 mm visual analog scale while the secondary outcomes were mean pain scores at 12 and 24 hours at rest and during movement postoperatively, the need for additional opioid analgesia, operative time, and side effects of study drugs. Results: baseline characteristic of participants were comparable between the two groups with no significant differences between them. There was a statistically significant difference between both groups regarding postoperative VAS score at 6 hours (46 (40 – 54) in TAP group, 54 (49 - 57)) in placebo group; p value <0.001). also, pain scores during movement at 6 and 12 hours postoperatively was significantly lower in TAP group (50 (44 - 58) & 26 (24 - 33) respectively) compared to placebo group (55.5 (53 - 61) & 24 (22 - 27) respectively; p value= 0.001, and 0.010). other outcomes as operative time, postoperative nausea and vomiting, the overall need for opioids postoperatively did not show statistically significant differences in both groups. Conclusion: The surgical TAP block provided better analgesic effect during the first six hours after cesarean delivery and reduced the consumption of opioids and could be used effectively as a part of multimodal analgesic measures, yet the analgesic effect faded away in the late post-operative period.