الفهرس 
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Abstract
A
cute severe pain after cesarean delivery is frequent. At least 10 to 15% of the women develop chronic pain. Effective postoperative analgesia after cesarean section is important because it enables early ambulation and facilitates breastfeeding.
The transversus abdominis plane (TAP) block is a regional analgesic technique that blocks T6–L1 nerve branches and has an evolving role in postoperative analgesia for lower abdominal surgeries.
Various techniques are used for postoperative pain relief after cesarean delivery under spinal anesthesia, including intrathecal and/or systemic opioids, abdominal nerve blocks, and truncal blocks such as the transversus abdominis plane (TAP) block with parenteral analgesics and bilateral erector spinae plane (ESP) block.
TAP block has gained popularity as an effective analgesia technique in mothers undergoing cesarean delivery and works by blocking the anterior rami of the spinal nerves of the anterior abdominal wall after spreading of the local anesthetic agent in the neurofascial plane between the internal oblique and transversus abdominis muscle, thereby relieving the pain of cesarean section.
The aim of the current study is to evaluate the effect of the Modified Surgeon Assisted Bilateral TAP block on the time required for the first analgesic dose after Cesarean Section under spinal anesthesia.
The current study was conducted at Ain Shams University Maternity Hospital on 60 pregnant women who were scheduled for elective caesarean section under spinal anesthesia all patients who fulfilled inclusion criteria were randomized to two groups; group A (TAP block, n=30): was received a TAP at the end of surgery using the Modified Surgeon Assisted Bilateral TAP block with bupivacaine 0.25% 40 ml. group B (placebo, n=30): was received TAP with 0.9% normal saline 40 ml.
Studying obstetric data of our patients showed that there was no statistically significant difference between two groups regarding gravity, parity, and history of abortion at a p-value of 0.823, 0.988, and 0.091, respectively. In addition, there was no statistically significant difference between two studied groups regarding weight, height, and BMI at p-value 0.281, 0.637, and 0.286, respectively.
Regarding the duration of operation there was no statistically significant difference between the two studied groups at p-value 0.752*.
Studying the visual analog scale (VAS) of the patients there was a statistically significant decrease in VAS representing pain felt by group A patients in duration from 2-24 hours post-administration of TAP block in comparison to VAS of group B in the same duration at p-value <0.001*
In the current study, postoperative nausea was not statistically significant between the two studied groups at p-value <0.905* Also, mobilization time was statistically significantly shorter in group A in comparison to group B at p-value <0.001*. In addition, concerning time of discharge from hospital time statistically significant difference between both groups at p-value 0.015*.
Moreover, there was a statistically significant difference between the two studied groups where in group B more patients received opioids and received it in a larger dose than in group A at p-value <0.001* and <0.001* respectively. Also, the time of administration of first analgesic dose was statistically significant earlier in group B rather than group A.
Therefore, TAP block by Modified Surgeon Assisted Bilateral TAP block technique is a safe and effective procedure compared to placebo and other post-operative analgesic techniques.
A
cute severe pain after cesarean delivery is frequent. At least 10 to 15% of the women develop chronic pain. Effective postoperative analgesia after cesarean section is important because it enables early ambulation and facilitates breastfeeding.
The transversus abdominis plane (TAP) block is a regional analgesic technique that blocks T6–L1 nerve branches and has an evolving role in postoperative analgesia for lower abdominal surgeries.
Various techniques are used for postoperative pain relief after cesarean delivery under spinal anesthesia, including intrathecal and/or systemic opioids, abdominal nerve blocks, and truncal blocks such as the transversus abdominis plane (TAP) block with parenteral analgesics and bilateral erector spinae plane (ESP) block.
TAP block has gained popularity as an effective analgesia technique in mothers undergoing cesarean delivery and works by blocking the anterior rami of the spinal nerves of the anterior abdominal wall after spreading of the local anesthetic agent in the neurofascial plane between the internal oblique and transversus abdominis muscle, thereby relieving the pain of cesarean section.
The aim of the current study is to evaluate the effect of the Modified Surgeon Assisted Bilateral TAP block on the time required for the first analgesic dose after Cesarean Section under spinal anesthesia.
The current study was conducted at Ain Shams University Maternity Hospital on 60 pregnant women who were scheduled for elective caesarean section under spinal anesthesia all patients who fulfilled inclusion criteria were randomized to two groups; group A (TAP block, n=30): was received a TAP at the end of surgery using the Modified Surgeon Assisted Bilateral TAP block with bupivacaine 0.25% 40 ml. group B (placebo, n=30): was received TAP with 0.9% normal saline 40 ml.
Studying obstetric data of our patients showed that there was no statistically significant difference between two groups regarding gravity, parity, and history of abortion at a p-value of 0.823, 0.988, and 0.091, respectively. In addition, there was no statistically significant difference between two studied groups regarding weight, height, and BMI at p-value 0.281, 0.637, and 0.286, respectively.
Regarding the duration of operation there was no statistically significant difference between the two studied groups at p-value 0.752*.
Studying the visual analog scale (VAS) of the patients there was a statistically significant decrease in VAS representing pain felt by group A patients in duration from 2-24 hours post-administration of TAP block in comparison to VAS of group B in the same duration at p-value <0.001*
In the current study, postoperative nausea was not statistically significant between the two studied groups at p-value <0.905* Also, mobilization time was statistically significantly shorter in group A in comparison to group B at p-value <0.001*. In addition, concerning time of discharge from hospital time statistically significant difference between both groups at p-value 0.015*.
Moreover, there was a statistically significant difference between the two studied groups where in group B more patients received opioids and received it in a larger dose than in group A at p-value <0.001* and <0.001* respectively. Also, the time of administration of first analgesic dose was statistically significant earlier in group B rather than group A.
Therefore, TAP block by Modified Surgeon Assisted Bilateral TAP block technique is a safe and effective procedure compared to placebo and other post-operative analgesic techniques.