الفهرس 
Cesarean DeliveryOnly 14 pages are availabe for public view
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Abstract
Objectives: comparing between transperitoneal guided TAP block
versus ultrasound guided TAP block. As regard of, time of first call of
analgesia, patient satisfaction, the amount of additional analgesic needed
for 24 hour postoperatively, duration of the procedure and complications
encountered in each procedure.
Background: Pain after cesarean section is usually described as
moderate to severe by most patients. Transverse abdominis plane (TAP)
block is a recently introduced regional technique that provide analgesia to
the anterior abdominal wall, which is administered under ultrasound
guidance or by transperitoneal surgical technique.
Material and Methods: Randomized, controlled, double blind
study on 70 women who underwent elective caesarean section distributed
into two groups each is 35 women. group STB: transperitoneal guided
TAP block was given after closing the uterus and establishing hemostasis.
group UTB: Ultrasound guided TAP block was done after closure of skin.
Results: The patients’ demographic and clinical characteristics
were matched between the two studied groups (P>0.05). Block procedure
duration (minutes) was shorter in Trans peritoneal TAP block group
(p<0.001). In a study comparing pain perception (VAS-10) between two
groups (surgical TAP and ultrasound-guided TAP block), there was no
significant difference between the groups at any of the measured time
points (2, 4, 8, 12, and 24 hours post-operation). Also, no significant
differences between the studied groups regarding changes in the
postoperative mean of VAS scores at 4, 8, 12, 24 h from the baseline
VAS score (at PO-2h).
Summary
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Our study found no significant difference between the two groups
in regards to postoperative Opioid analgesia (pethidine) requirements and
timing. Both groups had similar percentages (20% and 14.3%) of patients
requiring analgesia, with similar number of requests (71.4% and 80.6%)
and mean dose (64.3 mg and 60 mg). Additionally, there was no
significant difference in the time to first requirement of analgesia (9.1
hours vs 9.6 hours).
Our study show a similar level of satisfaction among both groups.
68.6% of patients in the surgical TAP group reported good satisfaction,
while 62.9% of patients in the ultrasound-guided TAP block group
reported good satisfaction, 31.4% of patients in the surgical TAP group
reported Excellent satisfaction, while 37.1% of patients in the ultrasoundguided
TAP block group reported Excellent satisfaction.
Finally, the results showed that side effects were rare in both the
surgical TAP group and the ultrasound-guided TAP block group. Nausea
was only reported in 2.9% of the surgical TAP group, with no reports in
the ultrasound-guided TAP block group. No cases of vomiting, sedation,
respiratory depression, transient femoral nerve palsy, bowel haematoma
or local anaesthetics toxicity were reported in either group.
Conclusion: USG and surgical TAP blocks were safe and had
similar efficacy in providing post-operative analgesia in pregnant women
following cesarean section under spinal analgesia. Surgical TAP block is
an efficacious, safe and rapid technique, particularly in patients in whom
sensory blockade is technically challenging, and does not require
additional equipment.