///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

The analgesic efficacy of ultrasound-guided transversus abdominal plane block for cesarean delivery

Abstract Number: 18
Abstract Type: Original Research

Hiroshi Ueyama MD1 ; Hideaki Hayashi MD2

Background: Early postoperative ambulation is thought to be essential for prevention of thromboembolic disease for patients undergoing cesarean section. Actually, however, early ambulation after cesarean delivery is not popular in Japan, because both systemic and neuraxial opioids can not provide adequate somatic pain relief.

The transversus abdominis plane (TAP) block is a new regional anesthesia technique that provides analgesia after lower abdominal surgery. We evaluated its analgesic efficacy in patients during the first 48 postoperative hours after cesarean delivery.

Methods: Twenty patients scheduled for elective cesarean section undergoing spinal anesthesia performed through a Pfannensteil incision were enrolled. Spinal anesthesia has done with 0.5% bupivacaine, 10 mcg of fentanyl and 0.1 mg of morphine. After operation, Patients assigned to the block group (n=10) received ultrasound-guided bilateral TAP block using 20ml of 0.5% ropivacaine to each side, and patients assigned to the control group (n=10) did not receive nerve block. Patients pain score were recorded at rest and during walking at 4, 8, 12, 24 and 48 h after operation.

Results: TAP block was successful in nine out of ten patients. Up to 24h after surgery, visual analog pain scores (VAS) at rest in both groups were decreased by about 3 in both groups. At all time points, there were no between-group differences regarding postoperative VAS at rest. However, the mean value of VAS at walking in TAP group was 3.1 during the first 24h, but not in control group, where the VAS was 7.2(P<0.05). In addition, nine patients in TAP group could walk without assistance during the study period, and reported high levels of satisfaction. In contrast, all the patients in control group needed assistance for walking during the first 8 hour. There were no observed adverse effects following nerve blocks.

Conclusion: A combination of TAP block and intrathecal morphine administration provides better pain relief at walking, and improved good patients satisfaction compared with the control group during the first 24h. We believe that ultrasound-guided TAP block is useful analgesic technique to achieve early postoperative ambulation.

SOAP 2009