Infiltration versus Transversus Abdominis Plane Block for Post-Operative Analgesia in Patients Undergoing Elective Lower Segment Caesarean Section under Spinal Anaesthesia

BACKGROUND Caesarean section is the most widely performed obstetric procedure. Even though epidural analgesia is the gold standard for lower abdominal surgery, search is on to have a good alternative where we want to avoid epidural analgesia. Transverses abdominis plane block is an emerging fascial plane block. METHODS A prospective randomized controlled study was conducted among 70 American Society of Anesthesiologists (ASA) I-II patients undergoing elective lower segment caesarean section under spinal anaesthesia. After written informed consent, the participants were divided into two groups randomly. After skin closure, bilateral TAP block was performed on Group T with 20 mL of 0.375 % inj. ropivacaine on each side whereas surgical site local infiltration was given with same amount of drug. Postoperatively VAS was recorded at 0, 2, 4, 6, 8, 10, 12 and 24 hr. Patient received intramuscular diclofenac 75 mg on demand by the patient or when VAS score was more than 4. The time taken for the first request of analgesia (T-rescue) was noted. RESULTS Time to first rescue analgesia was longer in group T (414.85 +/- 88.33 minutes) as compared to group I (250.85 +/- 43.86 minutes). Mean time for first request for analgesia (T-rescue) was significantly longer in the T group by 164 minutes (p-value = < .001) compared to I group. VAS score was significantly higher for infiltration group at 2 hr. and 4 hr. (1.97 +/- .70 and 3.77 +/- .54, p-value < .001). No side effects were recorded. CONCLUSIONS Patients who receive TAP block have longer postoperative pain free period. In our study we didn't find any major side effects of TAP block. In conclusion, TAP block was superior to surgical wound infiltration with respect to postoperative analgesia following caesarean delivery.