Analgesia
Conditions
Keywords
post-operative analgesia, Transversus Abdominis Plane Block
Brief summary
Postpartum analgesia is a common concern after Cesarean Section (CS). The quality of postoperative recovery is improved by opioid sparing pain control approaches. The transversus abdominis plane block (TAPB) is an effective technique for postpartum analgesia after cesarean section. Pregnancy results in thinning of the internal oblique aponeurosis; with increased incidence of missing the second pop to reach the transversus abdominis plane (TAP). The classic blind approach to the TAP is associated with several complications; so, it has been largely replaced by the ultrasound-guided approach to the TAP. The ultrasound-guided approach to the TAPB was first described by Hebbart and his colleagues in 2007.Ultrasound-guided TAPB improves the success of the block, reduces the volume of local anesthetic used and prevents the potential injury of adjacent structures. Surgical approach to the TAPB was also described, it is a quick and easy approach of establishing a reliable block. The surgeon performs an intra-abdominal approach to the TAPB; by which asepsis is easily attained, visible and tactile confirmation of correct needle placement may be achieved with no risk of damage to the viscera but care must be given to avoid injury of the inferior epigastric vessels.
Detailed description
Compare the Transversus Abdominis Plane Block via the modified surgeon assisted approach (Study group), to the ultra-sound guided approach (Control group); as regards the post-operative analgesia following Cesarean Section.
Interventions
PROCEDURETAPB
TAPB will be given to parturients whether by the modified surgeon assisted approach or by the ultra-sound guided approach.
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
21 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* ASA physical status I and ∏ * primigravidas * aged 21-40 years * BMI ˂ 40 * body weight ˃ 60 kg * singleton pregnancy * gestational age of ≥37 weeks * undergoing elective caesarean section under spinal anesthesia.
Exclusion criteria
* Parturient refusal * parturient with a BMI \> 40 * body weight \< 60 kg * ASA physical status ≥ III * known local anesthetic (LA) allergy •contraindications to spinal anesthesia * parturients who received analgesics in the past 24 hours * infection at the site of the block.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to rescue analgesia | 6 months | the time from the end of surgery until the first parturient's request for analgesia |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Efficacy of the modified surgeon assisted approach for TAPB on postoperative analgesia | 6 months | assessment of pain intensity at rest and on passive flexion of the hip and knee by the Numeric Pain Rating Score (NPRS) from 0 = no pain to 10 = worst pain. Assessment will be done at 2, 6, 12 and 24h postoperative. |
| Number of parturients requiring postoperative analgesia | 6 months | defined as pethidine needed by each parturient in the 24 hours postoperative period |
| Total dose of pethidine given | 6 months | defined as pethidine needed by each parturient in the 24 hours postoperative period |
| Time to the parturient's first ambulation | 6 months | the time to start of each parturient movement in the 24 hours postoperative period |
| The analgesic satisfaction 24 hours after operation | 6 months | parturients will be asked to report their satisfaction with pain management, assessed as 0 = weak, 1 = medium, 2 = good, 3 = very good, and 4 = excellent. |
Countries
Egypt
Outcome results
None listed