Objective: To compare the analgesic efficacy of ultrasound (US) guided TAP block with landmark technique guided TAP block for management of post-op pain after open appendectomy in patients of acute appendicitis. Methods: In this study, we include 80 patients of acute appendicitis who were planned for open appendectomy were included. The study was conducted from June-2021 to Jan-2022 in Nishtar Hospital Multan. In Landmark TAP group; TAP block was given using bupivacaine (0.25%) after completion of surgical procedure using blind landmark technique. In US TAP group; TAP block was administered under US supervision. VAS Score and time of first rescue analgesia were main study outcomes. Results: Mean age was 33.5±9.9 years in landmark TAP group and 32.8±10.4 years in US TAP group (p-value 0.75). There was no significant difference in mean VAS score at 1, 6, 12 and 18 hours after surgery between the groups, However, after 24 hours of surgery mean VAS score was higher in landmark TAP group; 3.5±1.2 versus 2.9±1.0 in TAP group (p-value 0.02). Time of first rescue analgesia was significantly prolonged in US TAP group; 1320.7±275.9 minutes versus 1180.4±320.7 minutes in landmark TAP group (p-value 0.04). Conclusion: Ultrasound guided TAP block is superior to landmark guided TAP block, as it provides better analgesic outcomes in comparison of landmark guided TAP block. Keywords: Ultrasonography, landmark technique, transversus abdominus plane block.

Objective: To compare the effect of bilateral transversus abdominis plane (TAP) block analgesia and intravenous tramadol in post-operative period following cesarean delivery under spinal anesthesia. Patients and Methods: In this randomized controlled trial we included 100 patients who underwent elective cesarean delivery from 1-June-2021 to 01-January-2022 in Nishtar Hospital Multan. All patients were given spinal anaesthesia using standard technique. In group A, patients were given TAP block at the end of the procedure. Group B, was given spinal anaesthesia alone with intravenous tramadol 50 mg and analgesia requirement were noticed at 12 hours postoperatively. Results: Mean age was 28.28±4.61 years. Mean BMI was 23.60±2.33 kg/m2. Mean gestational age of patients was 39.96±1.26 weeks. Mean duration of procedure was 48.10±5.39 minutes. Mean duration in TAP block was 48.53±5.30 minutes and in IV analgesia group was 47.67±5.50 minutes (p-value 0.42). Mean VAS for pain was 4.27±1.50. Mean VAS for pain in TAP block was 3.46±0.93 and in IV analgesia group was 5.07±1.56 with p-value of <0.001. The mean VAS score after 24 hours was 0.7±0.5 in TAP group versus 3.1±0.7 in IV analgesia only (p-value <0.0001). Time of first rescue analgesia was 212±60 minutes in TAP group versus 77±23 minutes in IV analgesia only group (p-value <0.001) [Table 1]. Conclusion: The use of the bilateral TAP block in patients undergoing elective cesarean delivery can reduce postoperative pain and analgesic usage for up to 24 hours after the procedure. Key Words: Transversus abdominis plane (TAP), block analgesia, intravenous tramadol, cesarean delivery, spinal anesthesia.