Drug Ropivacaine in Bilateral Transversus Abdominis Plane (TAP) Block Versus Intramuscular Diclofenac Injection for Post-Caesarean Analgesia: Comparing New Method with Traditional One.

Abstract

Background: Analgesia is an important aspect in post-operative period. Nowadays, various multimodal approaches are used for pain management in surgical patients. With these numerous options, the best choice in setting after LSCS remains debatable. In this study, safety and efficacy of regional blocks like TAP block with ropivacaine for pain control were analysed. This may emerge as a better option for pain control after LSCS with minimal adverse effects to both breastfeeding neonate and mother.

Materials and methods: 250 patients undergoing LSCS (emergency and elective) were prospectively randomized into two groups. One group received intramuscular diclofenac injections thrice daily while another received bilateral TAP block with 20 ml 0.75% ropivacaine. Visual analogue scale (VAS) score, dosage interval, duration of analgesia and rescue dosage requirement between two groups were recorded and analysed.

Results: The mean of total VAS score in group receiving TAP block was lower compared to group receiving IM diclofenac sodium (4.08 ± 3.01 Vs. 14.46 ± 3.98). Also TAP block provided longer duration of analgesia (1227.240 ± 408.118 min vs. 212.120 ± 81.506 min) in single administration. More patients of first group required rescue analgesia within 12 h. Seven patients of diclofenac group required stopping and shifting to alternate analgesic due to inadequate uterine contractions and required uterotonics administration.

Conclusion: 0.75% ropivacaine in TAP block was effective and had better analgesic and safety profile with comparable cost to IM diclofenac and hence should be recommended in this setting.