Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 12 , ISSUE 5 ( September-October, 2020 ) > List of Articles


Efficacy of Surgical Transversus Abdominis Plane Block in Patients Undergoing Cesarean Delivery

Penumuchu Sravani, Chaitanya Indrani, Sira P Rajanna, Rajiv K Saxena

Keywords : Postoperative analgesia, Postoperative pain, Surgical transversus abdominis plane block, Tramadol,Cesarean delivery

Citation Information : Sravani P, Indrani C, Rajanna SP, Saxena RK. Efficacy of Surgical Transversus Abdominis Plane Block in Patients Undergoing Cesarean Delivery. J South Asian Feder Obs Gynae 2020; 12 (5):302-306.

DOI: 10.5005/jp-journals-10006-1828

License: CC BY-NC 4.0

Published Online: 23-03-2021

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Background: The surgical transversus abdominis plane (TAP) block is an established technique for postoperative analgesia following abdominal surgery. However, it has not been practiced frequently by obstetricians. This work was done to study the efficacy of the surgical TAP block after cesarean delivery (CD). Materials and methods: The study included 100 women undergoing CD in MVJ Medical College and Research Hospital, Hoskote, Bengaluru, Karnataka. The operating obstetrician performed a surgical TAP block for 50 participants in the “Study” group. Twenty milliliters of 0.25% bupivacaine was injected in the transversus abdominis neurofascial plane, on either side. Another 50 participants were included in the “Control” group. Postoperatively, visual analog scores (VAS) for pain were monitored for 24 hours. Whenever the patient demanded rescue analgesia or VAS was recorded as 4 or more, rescue analgesia was administered with intravenous injection tramadol 50 mg. The time of the first rescue analgesia and the total dose of rescue analgesics required in the first 24 hours were recorded. The patients in the “Control” group routinely received intravenous injection tramadol 50 mg, 8th hourly for pain relief. Results: The difference in the mean VAS score at all time intervals between the two groups was statistically significant (p < 0.05). The mean time to first rescue analgesia in the “Study” group and “Control” group was 11.7 ± 7.344 and 2.1 ± 1.125 hours, respectively, and the total tramadol consumption was 50 ± 28.571 and 180 ± 26.726 mg, respectively. This difference was statistically highly significant (p < 0.001). Conclusion: Surgical TAP block is an important adjunct in the multimodal pain management strategy and should be practiced more often in obstetric practice.

PDF Share
  1. Netter FH. Back and spinal cord. In: Netter FH, ed. Atlas of Human Anatomy. Summit, New Jersey: The Ciba-Geigy Corporation; 1989. pp. 145–155.
  2. Netter FH. Abdomen postero lateral abdominal wall. In: Netter FH, ed. Atlas of Human Anatomy. Summit, New Jersey: The Ciba-Geigy Corporation; 1989. pp. 230–240.
  3. Rafi A. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 2001;56(10):1024–1026. DOI: 10.1046/j.1365-2044.2001.02279-40.x.
  4. McDonnell JG, O'Donnell B, Curley G, et al. The analgesic efficacy of transverses abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg 2007;104(1):193–197. DOI: 10.1213/01.ane.0000250223.49963.0f.
  5. McDonnell JG, Curley G, Carney J, et al. The analgesic efficacy of transversus abdominis block after caesarean delivery. Anaesth Analg 2008;106(1):186–191. DOI: 10.1213/01.ane.0000290294.64090.f3.
  6. French JLH, McCullough J, Bachra P, et al. Transversus abdominis plane block for analgesia after caesarean section in a patient with an intracranial lesion. Int J Obstet Anesthe 2009;18(1):52–54. DOI: 10.1016/j.ijoa.2008.06.005.
  7. Randall IM, Costello J, Carvalho JC. Transversus abdominis plane block in a patient with debilitating pain from an abdominal wall hematoma following cesarean delivery. Anesth Analg 2008;106(6):1928. DOI: 10.1213/ane.0b013e318170baf3.
  8. Belavy D, Cowlishaw PJ, Howes M, et al. Ultrasound-guided transversus abdominis plane block for analgesia after caesarean delivery. Br J Anaesth 2009;103(5):726–730. DOI: 10.1093/bja/aep235.
  9. Owen DJ, Harrod I, Ford J, et al. The surgical transversus abdominis plane block—a novel approach for performing an established technique. Br J Obstet Gynaecol 2011;118(1):24–27. DOI: 10.1111/j.1471-0528.2010.02779.x.
  10. Alaa-El-Din Wali A, Taher A, Abd-El-Fatah SM. Awareness, knowledge, and attitude of Egyptian women toward cesarean delivery: a cross-sectional survey. J South Asian Feder Obst Gynae 2020;12(4):203–208. DOI: 10.5005/jp-journals-10006-1768.
  11. Carney J, Finnerty O, Rauf J, et al. Ipsilateral transversus abdominis plane block provides effective analgesia after appendectomy in children: a randomized controlled trial. Anesth Analg 2010;111:998–1003. DOI: 10.1213/ANE.0b013e3181ee7bba.
  12. Carney J, McDonnell JG, Ochana A, et al. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg 2008;107(6):2056–2060. DOI: 10.1213/ane.0b013e3181871313.
  13. Petersen PL, Mathiesen O, Stjernholm P, et al. The effect of transversus abdominis plane block or local anaesthetic infiltration in inguinal hernia repair: a randomised clinical trial. Eur J Anaesthesiol 2013;30(7):415–421. DOI: 10.1097/EJA.0b013e32835fc86f.
  14. Charlton S, Cyna AM, Middleton P, et al. Perioperative transversus abdominis plane (TAP) blocks for analgesia after abdominal surgery. Cochrane Database Syst Rev 2010;8:CD007705.
  15. Johns N, O'Neill S, Ventham NT, et al. Clinical effectiveness of transversus abdominis plane (TAP) block in abdominal surgery: a systematic review and meta-analysis. Colorectal Dis 2012;14(10):e635–e642. DOI: 10.1111/j.1463-1318.2012.03104.x.
  16. Galante D, Caruselli M, Dones F, et al. Ultrasound guided transversus abdominis plane (TAP) block in pediatric patients: not only a regional anesthesia technique for adults. Anaesth Pain Intensive Care 2012;16:201–204.
  17. Brady RR, Ventham NT, Roberts DM, et al. Open transversus abdominis plane block and analgesic requirements in patients following right hemicolectomy. Ann R Coll Surg Engl 2012;94(5):327–330. DOI: 10.1308/003588412X13171221589856.
  18. Srivastava U, Verma S, Singh TK, et al. Efficacy of trans abdominis plane block for post cesarean delivery analgesia: a double-blind, randomized trial. Saudi J Anaesth 2015;9(3):298–302. DOI: 10.4103/1658-354X.154732.
  19. Kahsay DT, Elsholz W, Bahta HZ. Transversus abdominis plane block after caesarean section in an area with limited resources. South Afr J Anaesthe Analge 2017;23(4):90–95. DOI: 10.1080/22201181.2017.1349361.
  20. Poddar S, Tripathy S. Double-blind randomized controlled trial comparing the effect of closure vs nonclosure of peritoneum during cesarean section on postoperative pain. J South Asian Feder Obst Gynae 2019;11(3):167–171. DOI: 10.5005/jp-journals-10006-1691.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.