SUBCUTANEOUS SUBFACIAL BUPIVACAINE WOUND INFUSION VERSUS ULTRASOUND GUIDED TRANSVERSES ABDOMINIS PLANE BLOCK FOR POSTCESAREAN PAIN RELIEF AFTER GENERAL ANESTHESIA: A DOUBLE-BLIND RANDOMIZED CONTROLLED TRIAL
Mohamed Anwar Elnory1, Mohamed Hamed Abd al Rahman2
Department of Obstetrics and Gynecology1 & Anesthesia and Surgical Intensive care2, Benha Faculty Of Medicine, Benha University, Egypt.
Aim: The purpose of this trial was to compare ultrasound-guided bilateral transversus abdominis plane (TAP) block with subcutaneous subfacial local anesthetic wound infusion (WI) for analgesia after lower segment cesarean section (CS) performed under general anesthesia (CA). Patients and Methods: This prospective, double-blind, parallel group, randomized, concealed allocation, controlled, superiority study was performed at Benha University Hospital and El Hayat specialized center Benha, El-Qalubia, Egypt, from October 2014 to September 2015. 240 parturients undergoing CS were randomized in this trial, 112 parturients injected with 20ml bupivacaine 0.25% in either side as TAP block under ultrasound guidance while 110 parturients infused with 30ml subfacially and 10 ml subcutaneously of Bupivacaine 0.25% at the end lower segment CS performed under general anesthesia (GA). Primary outcome was total postcesarean Nalbuphine consumption while the secondary outcomes were pain intensity scores at rest and on movement evaluated by visual analogue scale (VAS) score as well as total non - steroidal anti-inflammatory drug (NSAIDs) consumption, time spent in recovery room (RR) , time to first ambulation, deepest level of sedation postoperatively, parturients satisfaction regards postcesarean analgesia at discharge and incidence of nausea, vomiting, Pruritus, analgesic side effects. Results: 222 parturients were included in final analysis. The average total Nalbuphine consumption was 28.6 +12.5mg in TAP block group versus 32.8 + 15.5 in WI group with mean difference of – 3.4 mg at 95% confidence interval (95% CI) of – 0.05 to 6.85, P = 0.07.As regards the secondary outcomes there was no significant difference between TAP block and WI groups in term of postcesarean pain intensity scores both at rest and on movement, time spent in RR, total NSAIDs consumption, time to first ambulation and parturients satisfaction regards postcesarean analgesia. The incidence of nausea, vomiting, pruritis and drug side effects were low in both groups. Conclusion: Wound infusion and TAP block didn't differ significantly after CS performed under GA in term of postcesarean total Nalbuphine consumption, pain intensity scores at rest and on movement and parturients satisfaction regard postcesarean analgesia