Transversus Abdominis Plane block under general anesthesia versus intrathecal morphine for pain management after elective cesarean delivery
DOI:
https://doi.org/10.51699/ijhsms.v2i12.3107Keywords:
TAP block, postoperative, somatic pain, ITMAbstract
Background: For women having cesarean deliveries, neuraxial anesthesia combined with neuraxial opioids is still a common and useful method of administering anesthesia and analgesia. Nevertheless, in certain circumstances, general anesthesia is necessary, which makes it impossible to employ neuroaxial drugs for postoperative analgesia; this has increased the usage of other pain management techniques in addition to the incidence of opioid-related side effects. Transversus abdominis plane (TAP) block has been suggested as a useful component of the multimodal regimen for managing post-delivery pain, so the study was designed to describe the postoperative analgesic efficacy of TAP blocks (without ITM) in comparison to ITM for cesarean section.
Methods: An interventional study on a total of 100 American Society of Anesthesiologists physical status I and II who were divided into two groups: 50 patients in Group I received intrathecal morphine as a postoperative analgesic after spinal anesthesia (ITM Group) and 50 other patients in Group II (TAP Group) received ultrasound-guided TAP block following surgery performed under general anesthesia. This research compares the pain management outcomes of two therapy groups (ITM and TAP) based on a statistical analysis of data collected using Statistical Package for Social Sciences(SPSS) version 20, which was examined, cleaned, and coded.
Results: the study shows that the ITM group had significantly lower postoperative pain intensity than the TAP group at all time points except for 6 and 8 hours after surgery, when the difference did not reach a significant value. Seven cases in (group I) need rescue nefopam versus eleven cases in (group II); none of the patients required tramadol during the first 24 hours postoperatively in both groups. In the ITM group, twenty-one cases (42%) develop postoperative side effects compared to twenty-nine cases (58%) in whom no side effects had been reported, whereas only one case (2%) in the TAP group complains from nausea. Maternal satisfaction with pain relief was similar in both groups.
Conclusions: 1. Intrathecal morphine is effective in the management of post-cesarean pain and provides a superior analgesic effect, although associated with undesirable side effects, in comparison with ultrasound-guided TAP block.2.Transversus abdominis plane block has a considerable potential to provide effective pain relief after cesarean section with no significant side effects. 3. Although the analgesic effect of TAP block covers only somatic pain, visceral pain at its worst did not appear to be prominent and was relieved by paracetamol and nefopam.4.TAP block can be considered as a valuable analgesic option for patients who cannot tolerate intrathecal morphine for analgesia after cesarean delivery or those having a high risk of nausea and vomiting.
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