الفهرس 
Cesarean sectionOnly 14 pages are availabe for public view
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Abstract
Cesarean section is the most common laparotomy procedure performed in
women worldwide, and its rate is progressively increasing. Post cesarean pain
remains a major morbidity, and optimal pain management is a crucial challenge
for obstetricians and anesthesiologists.
The use of CS has steadily increased world wide and will continue
increasing over the current decade where both unmet need and over use are
expected to coexist.
Hence, Pain management following surgery is essential since it impacts
the mother’s ability to care for her infant. Furthermore, inadequate pain
management may negatively impact healing and the mother-child connection,
both of which may contribute to longer-lasting postoperative discomfort.
Further strong reasons exist for women undergoing caesarean deliveries to
obtain adequate pain treatment because the risk of thrombo-embolic illness,
which is known to be elevated throughout pregnancy and puerperium, can be
reduced by early mobilisation. Pain relief for these women enhances their
ability to care for the infant and facilitates effective breastfeeding.
Currently, multimodal analgesic technique involving abdominal nerve
block with parenteral analgesics is becoming popular for these patients.
Pain and other sensations from the abdominal wall are transmitted to the
brain by the anterior branches of approximately seven spinal nerves (T6 to L1).
These nerves are travelling in a plane between the internal oblique and
transverses abdominis muscles. This plane, known as the transversus abdominis
plane (TAP).
Transversus abdominis plane (TAP) block has been shown to provide
good postoperative analgesia as it provides analgesia to the skin, muscles and
Summary
parietal peritoneum of the anterior abdominal wall from T7 to L1, The block has
no effect on innervation of the visceral peritoneum.
TAP block enables pain control through blocking sensory nerves by
injecting local anesthetics into the neurofascial plane in the abdominal muscles.
There are many methods of TAP block, anatomical landmark technique,
ultrasound-guided technique and surgeon-assisted technique, In our study we
used ultrasound-guided technique.
Ultrasound is becoming an important in regional anesthesia, allowing
real-time imaging of nerves. This increases rates of achieving a successful block
by allowing visualization of the injectate entering the correct plane.
IV patient-controlled analgesia (PCA) is now used widely in post
cesarean pain control, The goal of PCA is to efficiently manage pain at the
intended dose and time. This is accomplished by giving patients the freedom to
give themselves an on-demand bolus dose of medication. Each bolus may be
taken either by itself or in combination with another prescription. While various
analgesics can be employed, opioids and local anaesthetics are the most often
used medications.
The current study was designed to evaluate the efficacy and safety of
transversus abdominis plane block and patient-controlled analgesia for pain
relief after cesarean delivery.
Also, in the current study, 84 participants were randomized into 2 groups:
group I included 42 patients using USG TAP block technique and group II
included 42 patients using PCA technique.
Our study showed that there was no significant difference in age, BMI,
GA and parity between the studied groups.
Also, the current research showed that, although pain sensation degree by
using VAS (for assessment of pain) is decreased in both groups along the first
Summary
24 h post operative, the VAS values more significantly lower in PCA group
(group II) than in TAP block group (group I). It means that the PCA was
superior in pain relief post operative rather than TAP block due to its visceral
effect.
Also, regarding HR, there was no significant difference in HR post
operative between the studied groups In our study.
Our research did not find any differences between the effects of TAP
block and IV PCA on respiratory rate, which could be explained by the low pain
scores in both groups.
Regarding early mobilization of women in the studied groups, PCA
played a role in delaying patient mobilization due to its sedative effect when
compared to those receiving TAP block.
Regarding intestinal motility, it was observed to be audible in “TAP
block group” earlier than “PCA group. This might be attributed to the systemic
effect of PCA drugs.
In our study, regarding duration of analgesia, time of first analgesia, and
time of first ambulation were significantly lower in TAP block group compared
to PCA group.
Also, the number of patients who needed rescue analgesia was
significantly higher in TAP block group compared to PCA group.
To prevent the systemic effects of the opioids used in PCA, TAP block
was preferred. Furthermore, TAP block requires additional training and an
intraoperative ultrasound machine, whereas PCA can be done with ease. When
the medication dosages used in both procedures were changed, there were very
few complications or adverse effects of either kind.