الفهرس 
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Abstract
Cesarean section is one of the most performed surgical procedures. It is estimated that 15% of the births worldwide and 21.1% of the births in the developed world occur by cesarean section. Inadequate post-operative pain relief after the cesarean section may negatively affect mobilization, breastfeeding, and even the emotional bond between the mother and the infant, while effective analgesia improves the amount of breastfeeding and infant weight gain. Different methods are used for post-operative pain management during 24 hours in the cesarean section.
Managing pain following cesarean section is challenging. The analgesic regimen should be effective, safe, and devoid of side effects. Over recent years, there has been growing interest in regional nerve block techniques with promising results on efficacy, as they reduce the need of supplemental analgesia thereby lower the incidence of drug-related side effect. TAP block is a relatively new abdominal nerve block with excellent efficacy after a variety of abdominal surgeries including cesarean section.
Transverse abdominis plane (TAP) block is a recently introduced regional technique that blocks abdominal wall neural afferents between T6 and L1 and thus can relieve pain associated with an abdominal incision. TAP is a neurovascular plane located between the internal oblique and transverse abdominis muscles and nerves supplying abdominal wall pass through this plane before supplying anterior abdominal wall.
TAP block has been considered to have a low incidence of complications. Only a few complications have been reported secondary to the TAP block: intrahepatic injection in a patient with hepatomegaly, intraperitoneal TAP catheter misplacement without abdominal organ damage and an anaphylactic reaction after ropivacaine injection. Short-term femoral nerve palsy is a potential complication because of the proximity of the TAP and the femoral nerve.
As postoperative pain after cesarean is predominantly due to abdominal incision, we hypothesized that the TAP block if used as a part of multimodal analgesia will reduce the need of additional analgesic during 48 h after surgery (primary outcome), severity of pain and prolong the demand for first analgesic and improve patient satisfaction during postoperative period (secondary outcome).
To elucidate our results, this study was a prospective randomized controlled trial performed on women undergoing cesarean section consisted of 100 pregnant females admitted to outpatient clinic at the department of Obstetrics & Gynecology at Beni Suef University Hospital. All patients randomly divided into two groups, 50 patients for each group as patients of group I: included 50 patients received ultrasound-guided TAP block using bupivacaine and group II: included 50 ultrasound-guided TAP placebo injection {saline solution} during the period from April 2021 to October 2021.
The results of the current study can be summarized as follows:
• Mean of age, wight, high and BMI of the studied patients were (29.75±3.08 years, 69.04±7.70 kg, 1.64±0.10 m, 25.78±1.90kg/m2), respectively.
• There were no significant differences between the studied groups regarding age, weight, high, and BMI.
• Time to ambulation, visual analog scale (VAS) variation after 24h and 48 hours were significantly decreased among TAP group lower than control group (P< 0.05).
• Cumulative dose of morphine after 24h was significantly lower among TAP group than control group, (P<0.001). However, time of first analgesic was significantly increased among TAP group than control group (P<0.05).
• Multiple logistic regression analysis indicated that time to ambulation and time of first analgesic were the most factors association with post cesarean delivery analgesia (P=0.000). While, age, weight, BMI and blood Loss didn’t show any association post cesarean delivery analgesia (P> 0.05).