Aim: The purpose of this trial was to compare ultrasound-guided bilateral transversus abdominis plane (TAP) block with subcutaneous subfacial local anesthetic wound infusion (WI) for analgesia after lower segment ce-sarean section (CS) performed under general anesthesia (CA).
Patients and Methods: This prospec-tive, double-blind, parallel group, ran-domized, concealed allocation, con-trolled, superiority study was per-formed at Benha University Hospital and El Hayat specialized center Ben-ha, El-Qalubia, Egypt, from October 2014 to September 2015. 240 parturi-ents undergoing CS were randomized in this trial, 112 parturients injected with 20ml bupivacaine 0.25% in either side as TAP block under ultrasound guidance while 110 parturients infused with 30ml subfacially and 10 ml sub-cutaneously of Bupivacaine 0.25% at the end lower segment CS performed under general anesthesia (GA). Prima-ry outcome was total postcesarean Nalbuphine consumption while the secondary outcomes were pain intensi-ty scores at rest and on movement evaluated by visual analogue scale (VAS) score as well as total non - ste-roidal anti-inflammatory drug (NSAIDs) consumption, time spent in recovery room (RR) , time to first am-bulation, deepest level of sedation postoperatively, parturients satisfac-tion regards postcesarean analgesia at discharge and incidence of nausea, vomiting, Pruritus, analgesic side ef-fects.
Results: 222 parturients were included in final analysis. The average total Nalbuphine consumption was 28.6 +12.5mg in TAP block group versus 32.8 + 15.5 in WI group with mean difference of – 3.4 mg at 95% confi-dence interval (95% CI) of – 0.05 to 6.85, P = 0.07.As regards the second-ary outcomes there was no significant difference between TAP block and WI groups in term of postcesarean pain intensity scores both at rest and on movement, time spent in RR, total NSAIDs consumption, time to first ambulation and parturients satisfac-tion regards postcesarean analgesia. The incidence of nausea, vomiting, pruritis and drug side effects were low in both groups. |
