Efficacy of Bilateral Transversus Abdominis Plane and Ilioinguinal-Iliohypogastric Nerve Blocks for Postcaesarean Delivery Pain Relief under Spinal Anesthesia

Abstract

Background Caesarean delivery can be associated with considerable postoperative pain. While the benefits of transversus abdominis plane (TAP) and ilioinguinal-iliohypogastric (II-IH) nerve blocks on pain after caesarean delivery via Pfannenstiel incision have been demonstrated, no enough investigations on the comparison of these blocks on pain after caesarean delivery have been conducted in our setup. Method An institutional-based prospective observational cohort study was conducted to compare the analgesic efficacy of those blocks. We observed 102 postoperative parturients. The outcome measure was the severity of pain measured using a numeric rating scale. Result Twenty-four hours after surgery, the NRS score at rest was (0.90 ± 0.80) versus (0.67 ± 0.58) and at movement (1.2 ± 1.07) versus (0.88 ± 0.76) for the TAP and II-IH groups, respectively. Twenty-four hours after surgery, the mean tramadol consumption was (55.45 ± 30.51) versus (37.27 ± 27.09) mg in TAP and II-IH groups, respectively (p = 0.009). The mean first analgesic requirement time was also prolonged in the II-IH group. Conclusion and Recommendations There was no statically significant difference between TAP and II-IH blocks regarding postoperative pain score, but the II-IH block significantly reduced the total tramadol consumption and prolonged the time to first analgesic request than TAP. Thus, we recommend the II-IH nerve block.

Comparison of Bilateral Ilioinguinal-Ilioihypogastric Nerve Block Versus Transverses Abdominis Nerve Block for Post-Operative Pain Management for Parturient Undergoing Elective Cesarean Section in Dilla University Referral Hospital, Ethiopia, A Randomized Controlled Trial

“…Study design (non-randomized, retrospective), the use of intrathecal morphine & blocks done with ultrasound guided technique could have contributed for the difference seen to our nding [18]. Similarly a cohort by Seid et al, in a study done in Gondar, Ethiopia found that 24 hour total tramadol consumption was lower in II/IH group compared to TAP group (P = 0.009) [19]. Difference in study design and different people performing the blocks in their cohort could explain this discrepancy.…”

“…However, at 36 & 48 hour intervals was pain scores were lower in TAP compared to II/IH group both at rest & on purposeful movement (p < 0.0005). Seid et al, Anatoli Stav, et al & So ene Ben Marzouk et al found no difference in NRS score between groups both at rest and on movement during their 24 hour follow up for post cesarean section pain (P > 0.05) [19,24,25]. Our result is also supported by a study comparing TAP with IINB + wound in ltration for post-operative analgesia after inguinal surgery in adults, did not found signi cant difference in pain score between groups (P > 0.05) [26].…”

“…In contrast to our nding Seid et al and Bessmertnyj AE et al, found that time to rst analgesic request were longer in II/IH group compared to TAP group for post cesarean delivery patients with P < 0.05. [17,19]. The difference in study design in the former & technique of block (Ultrasound guided) in the later could have contributed for this difference.…”

Efektivitas Blok Transversus Abdominis Plane Pasca Operasi Caesar

“…Selain itu, efek samping terkait opioid ini dapat menghasilkan masalah lain untuk ibu yang baru melahirkan seperti keterlambatan inisiasi menyusui dini dan gangguan ikatan ibu/bayi. 4 Saat ini banyak cara yang paling aman dan efektif dari intervensi untuk manajemen nyeri pasca operasi caesar seperti anestesi lokal dengan infiltrasi kulit, analgesia epidural, dan blok bidang seperti tranversus abdominis plane (TAP) dan ilioinguinal-iliohypogastric (II-IH). 4 Oleh sebab itu perlu diketahui keefektivan dari blok TAP sebagai salah satu rejimen manajemen nyeri pasca operasi caesar.…”

The efficacy of TAP block versus ilioinguinal block for post-cesarean section pain management: A systematic review and meta-analysis

“…Controversy still exists regarding the analgesic efficacy of transverse abdominis plane (TAP) block versus ilioinguinal or iliohypogastric (IL/IH) nerve block for postoperative pain management following cesarean section [ 15 , 16 , 17 , 18 , 19 , 20 ].…”