Transversus abdominis plane block offers prolonged postoperative analgesia than surgical incision infiltration by bupivacaine in cesarean section patients

Background and objective: Postoperative pain requires a well-planned analgesia regimen to ensure adequate patient comfort, satisfaction, early mobilization and also to decrease the hospital stay after anesthesia. We conducted this study to compare the transversus abdominis plane block with direct infiltration of bupivacaine into surgical incision in cesarean section to prolong the mean duration of postoperative analgesia. Methodology: This Randomized control trial was conducted in department of anesthesia, Nishtar Hospital, Multan from July 2016 to December 2016. A total of sixty patients were included in the study and randomly divided into two equal groups of 30 each; Group-T and Group-I. Group-T received TAP block with 0.3 ml/kg of 0.25% bupivacaine on each side under double pop technique, and Group-I received 0.6 ml/kg of 0.25% bupivacaine infiltration in surgical incision. Postoperatively all the patients were monitored in PACU. VAS was noted at 1/2, 1, 2, 4 and 6 h intervals. Inj tramadol 1.5 ml/kg was given as rescue analgesia when VAS score [greater than or equal to] 4. Time to requirement of first rescue analgesia was noted. Sample size was calculated with 80% power of test, 95 % confidence interval taking mean and standard deviation of rescue analgesia in Group-T 148 [+ or -] 46.7 and in Group-I 85.38 [+ or -] 38.07. Data were analyzed with computer software SPSS version 23. Mean [+ or -] SD was calculated for quantitative variables and frequency (percentage) was calculated for qualitative variables. Student t-test and chi square test were applied. P value 0.05 was considered as significant. Results: Mean VAS score at half hour in Group-T was 3.8 [+ or -] 2.9 and in Group-I was 5.0 [+ or -] 3.0; and mean VAS score at one hour was 4.4 [+ or -] 3.01 in T Group and in Group-I was 5.3 [+ or -] 3.09 respectively; at two hours 4.7 [+ or -] 2.9 and 6.3 [+ or -] 4.2, and at four hours was 5.2 [+ or -] 2.9 and 5.7 [+ or -] 2.8 in Group-T and Group-I respectively. Mean VAS score during six hours was 5.5 [+ or -] 2.8 and 6.1 [+ or -] 2.5 in Group-T and Group-I respectively. Mean time for 1st analgesia in Group-T was 296.3 [+ or -] 37.1 min and in Group-I was 202.0 [+ or -] 34.9 min, by applying t-test P= 0.000 a significant value. Conclusion: TAP block is a promising technique in alleviating postoperative pain in patients' cesarean section. The procedural simplicity of this block, along with reliable level of analgesia (T10-L1), and longer duration makes the