الفهرس 
Closure of layers of the anterior abdomen
Pathophysiology of PainOnly 14 pages are availabe for public view
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Abstract
Background:
Cesarean section remains by far the most common
surgical procedure performed for female population, and for
sure post-operative pain is an issue that matters most. In fact,
post-operative pain may be one of the main reasons patients
may refuse to do cesarean section. Post-operative analgesia
can be provided for the patients in many forms starting from
simple parenteral analgesics as NSAID‟s and paracetamol up
to neuraxial narcotics. Many local techniques have been
developed to alleviate post-operative pain, tranversus
abdominis plane block is a relatively newly technique that was
introduced to control pain after abdominal surgeries. TAP
block can be done either transcutaneous using anatomical
landmarks or ultrasound guided, or can be done by open
surgical technique as described in our study.
Aim of the work:
Study the analgesic effect of the surgical transversus
abdominis plane (TAP) block as regard the pain score in the
post-operative period in patients undergoing cesarean section.Objectives of this study:
- Primary objective: assessing the pain score in the
postoperative period either with or without the surgical
TAP block.
- Secondary objectives: assessment of:
Postoperative nausea and vomiting in both groups.
Early ambulation.
Required doses of opioid analgesics and their
adverse effects.
Possible complication(s) for the surgical TAP
block, for example hypotension, arrhythmia or
anterior abdominal wall hematoma.
Patients and methods:
The current study included 100 women undergoing
cesarean section. The patients were randomized in 2 groups,
group 1, who received surgical TAP block in addition to
conventional analgesia (cases) and group 2, who received
conventional analgesia plus placebo (control group). The cases
received surgical TAP block by the end of cesarean section
after closure of the uterus (bupivacaine 0.25%) in addition to
the other conventional analgesics to control post-operative
pain. Control group received placebo in the form of 20 ml of
normal saline injected in the transversus abdominis plane on both sides. Comparison between the two groups included postoperative pain scoring using visual analogue scale at 6, 12 and
24 hours, post-operative nausea and vomiting, side effects of
the local anesthetic “bupivacaine” (pruritus, hypotension or
arrhythmia), early ambulation and the required doses of opioid
analgesia.
Results:
The pain scores at 6 hours during rest in the surgical
TAP group ranged between 40-54 mm, while in the control
group, the pain scores ranged between 49-57 mm, with p-value
<0.001, the difference as noted is statistically significant.
Observing pain scores at 12 and 24 hours during rest showed
no clinical or statistical difference. The post-operative pain
scores during movement at 6 hours in the surgical TAP group
ranged between 44-58 mm, while in the control group ranged
between 53-61 mm, with P-value <0.001. Pain scores at 12
hours also showed statistical difference (p-value<0.010) with
pain scores ranging between 24-33 mm and 22-27 mm in the
TAP and control groups respectively. Lastly, pain scores at 24
hours showed no difference between both groups. As regard
opioid consumption post-operatively, 11 women from the TAP
group requested 1 dose (100 mg) of intramuscular pethidine
compared to 21 women from the control group. Furthermore,six cases requested 2 doses (200 mg) of pethidine, two cases in
the control group and four cases in the TAP group. Postoperative nausea and vomiting occurred in six women from the
TAP group compared to nine women in the control group. No
other side effects related to the injection of local anesthetic
including pruritus, hypotension, arrhythmia or hematoma
formation were noticed in both groups.