A randomised comparative study of transversus abdominis plane block with or without intravenous diclofenac sodium as a component of multimodal regimen for post-operative analgesia following caesarean section

Aims: Post-operative analgesia is a major component of perioperative care. An ideal method of pain relief after caesarean section should be cost-effective and safe for mother and baby. This study aims to evaluate the analgesic efficacy of transversus abdominis plane (TAP) block combined with intraoperative diclofenac aqueous for post-operative analgesia in caesarean section. Methods: A prospective randomised double-blind study was conducted on 60 patients over a period of six months. Patients were enrolled in two groups (n = 30). Group A and Group B both received bilateral landmark based TAP block using ropivacaine 0.75% (1.5 mg/kg), 20 ml at end of surgery. Group B received diclofenac sodium aqueous 75 mg intravenous intraoperatively. Results: The difference of visual analogue score (VAS) at movement was significant at 4 and 6 h in Group A versus Group B (3.00 +/- 0.64 versus 2.37 +/- 0.89, 4.43 +/- 0.68 versus 3.53 +/- 1.2). At rest, VAS score was lower in Group B than in Group A at all time intervals (P < 0.05). Time to demand of first dose of rescue analgesic was prolonged in Group B (11.5 +/- 4.1 h) than in Group A (7.55 +/- 1.41 h). Mean dose of analgesic consumption in first 24 h was lesser in Group B (61.67 +/- 34.57 mg) than in Group A (98.33 +/- 37.68 mg). Patient satisfaction score was higher in Group B (8 +/- 1.04) than in Group A (6.23 +/- 1.04). Conclusion: TAP block along with intraoperative diclofenac aqueous as component of multimodal regimen provides superior post-operative analgesia and better patient satisfaction as compared to TAP block alone.