The Analgesic Efficacy of Transverse Abdominis Plane Block versus Epidural Block after Caesarean Delivery: Which One Is Effective? TAP Block? Epidural Block?

Abstract

Introduction and Objective TAP block has gained popularity to provide postoperative analgesia after abdominal surgery but its advantage over epidural analgesia is disputed. For lower abdominal surgeries, epidural analgesia has been the gold standard and time-tested technique for providing postoperative analgesia, but contraindications for the same would warrant need for other equally good analgesic techniques. The objective of this study is to compare the analgesic efficacy of both the techniques. Materials and Methods Eighty patients in the ASA I-II risk group, undergone an elective C-section, were randomly assigned to the study. In the TAP group, before the C-section, a single-dose spinal anaesthesia was performed by administering 3 ml of 0.5% hyperbaric bupivacaine to the patients when they were in the sitting position. After the C-section, an ultrasound-guided bilateral TAP block was performed in these patients in the recovery room for postoperative analgesia. In the single-dose EPI group, the patients received 16 cc of isobaric bupivacaine, 3 mg of morphine, and 50 mcg of fentanyl, making a total volume of 20 cc and being administered to the epidural space. Results A higher level of patient satisfaction was observed in the EPI group (p=0.003). The amount (mg) of total analgesics received by the patients in the first 24 hours of the postoperative period was statistically significantly higher (p=0.021) in the TAP group compared to the EPI group. The visual analogue scale (VAS) scores of the EPI group were significantly lower compared to that of the TAP group (p < 0.001). Conclusion The epidural anaesthesia is still the golden standard to achieve a postcaesarean analgesia. Epidural anaesthesia is a considerably effective method in controlling the postoperative pain. We are of the opinion that epidural anaesthesia should be preferred in the first place to achieve a successful postcaesarean analgesia as it provides more effective pain control.

Epidural vs. transversus abdominis plane block for abdominal surgery – a systematic review, meta‐analysis and trial sequential analysis

“…Of the initial 3213 unique article citations identified by the search strategy, 18 randomised controlled trials fulfilled the inclusion criteria [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Details of the screening process are illustrated in Fig.…”

“…1 placed [19,26]. In nine trials, the approach of the TAP block was lateral [15,16,18,19,24,[26][27][28][29], whereas it was subcostal in four trials [21][22][23]30] and combined or either lateral or subcostal in five trials [14,17,20,25,31].…”

“…In 13 trials, the abdominal surgery was open 14,16,17,19,20,22,23,25,26,28,29,30; in one trial it was laparoscopic 31; and in four trials it was combination of open, laparoscopic and robotic or otherwise undefined 18,21,24,27. The main mode of anaesthesia was general in most trials 14,16,17,18,19,20,21,22,23,24,25,26,28,29,30,31 and neuraxial in two trials 15,27. Transverse abdominis plane block was performed under ultrasound guidance in all of the trials but three, where it was either inserted using the landmark technique 29 or surgically placed 19,26.…”

<p>Comparison of Analgesic Effect Between Erector Spinae Plane Block and Transversus Abdominis Plane Block After Elective Cesarean Section: A Prospective Randomized Single-Blind Controlled Study</p>

“…3,4 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 abdominal anterior wall after spreading of the local anaesthetic agent in the neurofascial plane between the internal oblique and transversus abdominis muscle, thereby relieving the pain of cesarean section. 5 Recent publications have demonstrated that the ESP block serves as a practical component of a multimodal regimen for pain relief after various types of operations, including cesarean delivery, by blocking both the dorsal and ventral branches of the thoracic and abdominal spinal nerves; therefore, it provides both somatic and visceral analgesia. 4,6 We hypothesized that bilateral ESP block would provide more effective and prolonged pain relief than TAP block after elective cesarean delivery and could be used as part of a multimodal opioid-sparing analgesia technique.…”

Anesthesia and analgesia for FAUCS technique of cesarean section – case report

“…Pregledni članci i metaanalize sugeriraju da bi blok TAPa nakon tradi cionalnog SCa mogao biti posebno učinkovit pri smanjenju poslijeoperacijske boli i manjoj konzuma ciji opioida, a ujedno i komplikacija vezanih uz opioi de. [9][10][11] Prema dosad objavljenoj literaturi, sugerira se da bi blok TAPa trebalo primjenjivati kod SCa koji su rađeni u općoj anesteziji i u rodilja kojima nisu davani dugodjelujući neuroaksijalni opioidi 9,[12][13][14] Trenutačno ne postoje specifične smjernice za anesteziju ekstrape ritonealnih SCa i, prema našim saznanjima iz litera ture, ne nalazimo istraživanja o učinkovitosti bloka TAPa kod FAUCSa ili drugih vrsta ekstraperitoneal nih SCa. Zbog toga ne možemo usporediti svoja isku stva s iskustvima drugih.…”