Abstract

Background: Postoperative pain management plays a key role in perioperative anaesthesia care. Postoperative analgesia can be achieved by the use of oral or parenteral analgesics like NSAIDS and opiods. However, opioids are associated with dose dependent side effects including nausea, vomiting, pruritis, sedation and respiratory depression. Techniques that reduce opioid requirements such as peripheral nerve blocks, neuraxial blocks with local anaesthetics, intrathecal opioids and adjunctive techniques may be beneficial to the patient. Transversus abdominis plane block has recently been described as an addition or alternative to the other analgesic regimes. TAP block has been shown to reduce postoperative opioid use in elective abdominal surgery, including open appendicectomy, laparotomy, Caesarean section and laparoscopic cholecystectomy.1 Aim: The purpose of this study was to compare the efficacy of Ultrasound guided Transversus abdominis plane (TAP) blocks with local site infiltration using 0.2% Ropivacaine in providing postoperative analgesia in patients undergoing elective caesarean section surgeries. Objectives: To study the time taken for first dose administration of rescue analgesic. To study the total amount of analgesic consumed and the assessment of patient satisfaction. Material: After obtaining approval from the ethical committee and obtaining informed consent, 60 pregnant women aged 20-40 years posted for elective caesarean section surgeries were randomly divided into Group T and Group L. Bilateral TAP block was performed in Group T after the completion of surgery, under ultrasonography guidance with a Sonosite M Turbo portable ultrasound unit with a linear 5-10 MHz probe. A 100mm long, 22G short bevel needle (Stimuplex, B. Braun Melsungen AG, Germany) was used to administer a total of 40ml (20ml for each side) of 0.2 % Ropivacaine for the TAP block. In group L, post-operatively a total of 40ml of 0.2% Ropivacaine was used for subcutaneous wound site infiltration. The Srikanth Reddy Karkala, Pradeep Uday Kiran Boddu, Anuradha Suresh Deolalkar et al. Comparison of Ultrasonography Guided Bilateral Transverse Abdominis Plane (TAP) Block And Local Site Infiltration With 0.2% Ropivacaine for Post Operative Analgesia Following Caesarean Section. parameters recorded were intraoperative haemodynamics, postoperative pain scores and the need for rescue analgesia in the first 24 hours postoperatively. Results: A total of 60 patients were analyzed. Duration of analgesia was significantly longer 5.5±2.8 hours in group T compared to group L 2.5±1.36 hours (p<000.1), mean consumption of diclofenac was 107.5±37.8 mg and 162.5±34.585 mg in group T and L respectively (p<0.001). Conclusion: Post-operative analgesia and patient satisfaction is better with ultrasound guided TAP block than with local site infilteration.

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