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

Abstract

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.

Comparison of different nonsteroidal anti-inflammatory drugs for cesarean section: a systematic review and network meta-analysis

“…In all, we included 47 trials in this review [ 10 , 11 , 25 – 69 ] and details of the screening process are illustrated in Fig. 1 .…”

“…1 . The following interventions were compared: control vs. celecoxib in two trials [ 35 , 46 ]; control vs. celecoxib + parecoxib in one trial [ 57 ]; control vs. diclofenac in 24 trials [ 11 , 25 – 34 , 36 – 43 , 65 – 69 ]; control vs. diclofenac vs. indomethacin in one trial [ 44 ]; control vs. diclofenac vs. ketoprofen in one trial [ 45 ]; control vs. ibuprofen vs. ketorolac in one trial [ 47 ]; control vs. indomethacin in one trial [ 48 ]; control vs. ketorolac in six trials [ 10 , 49 – 53 ]; control vs. naproxen in one trial [ 54 ]; control vs. parecoxib in one trial [ 55 ]; control vs. tenoxicam in six trials [ 56 , 58 – 62 ]; diclofenac vs. ketoprofen in one trial [ 63 ]; and ketorolac vs. parecoxib in one trial [ 64 ]. The findings of the risk of bias assessment are presented in Fig.…”

“…2 . Overall, only four trials were deemed to be at low risk of bias [ 10 , 54 , 55 , 68 ], and 30 and 13 of the remaining trials were evaluated to have some concerns [ 25 , 27 – 35 , 37 , 38 , 43 – 45 , 47 , 49 , 52 , 53 , 57 – 67 ] or be at high risk of bias [ 11 , 26 , 36 , 39 – 42 , 46 , 48 , 50 , 51 , 56 , 69 ], respectively. Many of the concerns were related to the randomization process, measurement of the outcome, and the selection of the reported result.…”

“…Different NSAIDs may produce varying pain relief efficacy and have differing side effect profiles, and hence a comparative analysis of NSAIDs is important. Several randomized trials investigating NSAIDs have been published recently [ 10 , 11 ], and a contemporary review would update the available evidence for the use of NSAIDs in cesarean section.…”

Neural blocks at the helm of a paradigm shift in enhanced recovery after surgery (ERAS)

“…[ 11 12 ] These blocks are also being currently utilised as a part of multimodal analgesia regimen in various gynaecological, obstetric procedures as well as laparoscopic bariatric surgeries. [ 13 14 15 ]…”