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Optimization of transversus abdominal plane block (TAP-block) for postcesarean pain relief
Abstract Number: T5D-1
Abstract Type: Original Research
Optimization of transversus abdominal plane block (TAP-block) for postcesarean pain relief.
Following the onset of a painful peripheral stimulus, nociceptive neurons are activated to initiate a cascade of action potentials that propagate along the axons of the primary afferent fibers (C and Aδ fibers) to the nerve terminals found in laminae I and II of the dorsal horn in the spinal cord. Early predictive analgesia helps to reduce the sensitization of that neurons, which can contribute to fast ambulation and reduce analgesics demand in postoperative period.
Materials and Methods:
This prospective study included 60 patients scheduled for cesarean delivery under spinal anesthesia (Bupivacain spinal heavy 0.5% - 2.2 ml (+/-0.2 ml) without any opioid adjuvants). They were randomly assigned into two groups to receive transversus abdominis plane block (TAP-block) with 40 mL of 0.375% ropivacaine with dexamethasone 4mg with a persistent sensor-motor block (Group 1), and similar analgesia regiment with the regression of the neuraxial block and the appearance of complaints of pain (Group 2).
Primary outcome was duration of post cesarean analgesia; secondary outcomes included first request of analgesia, Numeric Rating Scale for Pain (NRS Pain) and time of ambulation.
In Group 1 duration of postoperative analgesia was significantly, longer (19+/-2.5h) compare to Group 2 (14+/-3.25h). Requirement of parenteral analgesics in Group 2 was higher. NRS(Pain) value was lower in Group 1. Ambulation was similar in both groups.
Early setting of TAP-block reduces the need for parenteral analgesics, the value of NRS (pain) is lower, which may indicate a decrease in activation / sensitization of neurons of the horn of the spinal cord. Further research is required.