Analgesic Efficacy of Trans Abdominis Plane Block in Women Undergoing Cesarean Section: a Randomized Study.

Analgesic efficacy of trans abdominis plane block in women undergoing Cesarean section: a randomized controlled trial.

Introduction:

Cesarean section is considered as one of the most commonly performed surgery worldwide. Based on the data from 121 countries, the trend analysis showed that between 1990 and 2014, the global average CS rate increased 12.4% (from 6.7% to 19.1%) with an average annual rate of increase of 4.4%.Its incidence in 2010 and 2013 was 41.9% and 48% respectively which was contrary to the rate of C/S recommended by the World Health Organization as fifteen percent for year 2014 .Just like all other major abdominal surgeries, c section comes with severe postoperative pain ,which if not managed properly can not only leads to prolonged immobility and its associated adverse effects but can also affect mother-baby bonding, care of baby, breast feeding and may lead to chronic pain and post-partum depression Multiple modalities are available for managing this post cesarean pain. Mostly systemic opioids are used but they are often associated with a number of undesirable side effects such as nausea, vomiting, pruritus, constipation, and respiratory depression,sedation.Other than opoids, systemic NSAIDS such as ketorolac, acetoaminophen are also used but alone they may be insufficient to treat post cesarean pain. Other analgesic options currently being used include local anesthetic techniques (local anesthetic infiltration, neuraxial blocks) acetaminophen , cyclooxygenase-2-specific inhibitors as well as analgesic adjuncts such as steroids, ketamine and α-2 agonists such as clonidine.

Neruoaxial anesthesia such as lumbar or thoracic epidurals are also used but because of constant and strict monitoring ,they are not considered economical for patients as well as for hospitals. With recent advancements in regional anesthesia, some regional blocks are now being utilized for postoperative pain relief in c sections such as TAP blocks but their use is still limited because of nonavailability of sufficient data.

Transversus abdominis plane (TAP) block provides analgesia by blocking nerves in anterior abdominal wall through introduction of a long-acting local anesthetic solution between the internal oblique and transversus abdominis muscles. Its use in c section is still limited ,but is considerd to be increased in future as is now been shown by several studies .