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Transversus Abdominis Plane Block Versus Rectus Sheath Block for Postoperative Pain After Cesarean Delivery: A Randomized Controlled Trial
Abstract Number: F3A-336
Abstract Type: Original Research
Background: Undesired effects of pain can be prevented with efficient postoperative analgesia in patients who undergo cesarean operations. In addition, relationship with the mother and her new born baby will be provided earlier. With this study, we aimed to compare the postoperative analgesia effects of rectus sheath (RS) block and transversus abdominis plane (TAP) block in patients who undergo elective cesarean operations.
Methods: After receiving Ethical Committee approval and informed consent, 90 ASA I-II, aged 18-45 years, have >37 gestation weeks who were scheduled for elective cesarean operation were included to this study. Spinal anesthesia was performed with bupivacaine and fentanyl. At the end of the surgery, 1 gr iv paracetamol was given and the patients were provided with iv morphine patient controlled device. Patients were randomised into three groups with closed envelope technique. Bilateral ultrasound guided TAP block was performed to TAP group with 20 mL 0,25% bupivacaine, bilateral ultrasound guided rectus sheath block was performed to RS group with 20 mL 0,25% bupivacaine and no block was performed to control group. Primary object of this study was to compare the analgesia effects and morphine consumption between TAP block and rectus sheath block. Secondary outcomes were to compare the incidence of nausea and vomiting and the satisfaction rates of the patients.
Findings: NRS scores of both while resting and coughing were lower in TAP group at postoperative 2nd, 3rd, 6th, 12th and 24th hours (p<0,05). Morphine consumption was lower in TAP group at postoperative 1st, 2nd, 3rd, 6th, 12th and 24th hours (p<0,05). Patient satisfaction was higher in both TAP and RS groups compared to control group (p<0,05). Nausea and vomiting were lower in TAP group but it was statistically insignificant.
Discussion: TAP block provides efficient postoperative analgesia in patients who undergo cesarean operation however postoperative analgesia provided with rectus sheath block is inadequate in patients who undergo cesarean operation.
Keywords: Cesarean operation, postoperative analgesia, transversus abdominis plane block, rectus sheath block