Somatic and Visceral Analgesia in Cesarean Section: Transversus Abdominis Plane Block and Intraperitoneal Local Anesthetic Infiltration

Document Type : Original Article

Authors

1 Anesthesia department, Faculty of Medicine, Mansoura University

2 Mansoura University Hospitals

3 Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

4 Department of Anesthesia, Surgical Intensive Care and Pain, Faculty of Medicine, Mansoura University, Egypt.

Abstract

Background: Cesarean section [CS] remains the most prevalent surgical practice globally that’s accompanied with significant postoperative [PO] pain. Transversus abdominis plane block [TAPB] is considered the most preferred truncal block performed to control post-CS pain and discomfort. Intraperitoneal local anesthetics [IPLA] instillation has received the attention of many researchers recently; it had a remarkable visceral pain relief after many procedures. Dexamethasone [DEX] and epinephrine [EPN] were used as adjuvants to LA.
The aim of the work: The study aimed to assess the analgesic effect of ultrasound-guided [USG] TAPB or IPLA and their combination using bupivacaine, EPN, and DEX for the management of post-CS somatic and visceral pain.
Patients and methods: In this randomized, double-blinded study, we compared 3 groups: intraperitoneal [IP], TAP [T], and their combination [C] using bupivacaine 0.2% with DEX and EPN in 102 pregnant females scheduled for CS under spinal anesthesia [SA], concerning the time required until the first analgesic request as the primary outcome.
Results: Group C recorded significantly delayed first requests for both paracetamol [12h] and opioids [14.5h] compared to IP [10 and 13 h] and T groups [10 and 12.25 h], along with the lowest significant total analgesic consumptions, while the T group had the highest. The dual-block group provided superior control for somatic and visceral pain during rest and movements, as evidenced by better visual analogue score [VAS] values than either single-block group.
Conclusion: TAPB proved to have a beneficial effect in the management of post-CS pain, especially the somatic component, while IPLA allows more control over visceral pain. The addition of IPLA to TAP allows more somato-visceral control, reducing pain scores and analgesic consumption and providing more patient satisfaction.

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