Assessment of postoperative analgesia with transversus abdominis plane block in patients undergoing cesarean section with spinal anesthesia

In this study, the postoperative analgesic efficacy of ultrasound guided transversus abdominus plane block (TAPB) was assessed in pregnant women undergoing cesarean section with spinal anesthesia. After obtainment of ethics committee approval and written informed consent from patients, a total of 50 women between 18 and 45 years of age with an ASA risk status of I-II and undergoing elective cesarean section under spinal anesthesia were included in this study. Patients were divided into two groups as follows: those who received postoperative TAPB under ultrasound guidance (Group TAPB, 20 ml of 0.25% bupivacaine administered bilaterally), and those who did not receive postoperative TAPB (Group C). Also, all patients were provided patient-controlled analgesia with tramadol (loading dose of 20 mg, with a lock-out time of 10 minutes and basal infusion rate of 20 mg/hour). In order to assess the level of postoperative analgesia, VAS scores were recorded with 5-minute intervals after entry into the recovery room and at postoperative 1, 2, 4, 6, 12 and 24 hours. Also recorded were the tramadol doses at recovery and at postoperative 24 hours. Patient satisfaction was assessed postoperatively at 24 hours. The two groups were comparable with respect to demographic characteristics. Tramadol use (in milligrams) in group TAPB during recovery (32.5 ± 15.51) and postoperative 24 hours (226.00 ± 66.44) was significantly lower as compared to Group C (47.52±19.15 and 280.80±35.34, respectively) (p<0.01). Also subjects in group TAPB had significantly lower VAS scores at 5, 10, 15, 20, 25, 35, 40, 45, and 50 minutes during recovery, and at 1, 2, 3, 4, 6 and 12 hours postoperatively (p < 0.05). Also, subjects in group TAPB reported significantly higher patient satisfaction (p<0.05). In conclusion, ultrasound-guided TAPB was found to be associated with significantly lower VAS scores, reduced need for analgesics, and improved patient satisfaction. In women undergoing cesarean section with spinal anesthesia, routine use of TAPB may be considered based on its favorable impact on postoperative analgesia. Keywords: Transversus abdominus plane block, spinal anesthesia, cesarean section