Ultrasound Guided Abdominal Field Blocks Improve Postoperative Pain Relief in Cesarean Delivery: a Prospective Randomized Controlled Study. | [Anaesthesia, Pain and Intensive Care • 2017]

Author(s):

1. Vibhuti A Shah: Department of Anesthesiology, AMC MET Medical College, Sheth LG Municipal General Hospital, Ahmedabad, Gujara, India

2. Manan Bajaj: Department of Anesthesiology, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India

3. Khushali R Tilvawala: Department of Anesthesiology, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India

Abstract:

Background: Abdominal field blocks with local anesthetic solutions have been suggested in postoperative analgesia in patients undergoing abdominal wall incisions. In the present study we assessed the analgesic efficacy of ultrasound guided rectus sheath and transversus abdominis plane blocks over first 24 postoperative hours after cesarean deliveries performed through pfannensteil or midline incisions. Methodology: Sixty women undergoing elective or emergency cesarean delivery were enrolled in this randomized, controlled, double-blind trial, and then randomized either to undergo ultrasound guided rectus sheath and transversus abdominis plane blocks with bupivacaine (n=30) or no block (n=30). Inj diclofenac and inj. paracetamol 1 G, were given to all patients, and inj tramadol was given on request as a rescue analgesic. All patients received a spinal anesthesia with 0.5% heavy bupivacaine, and at the end of surgery (after the skin sutures) bilateral rectus sheath and transversus abdominis plane blocks were performed using 15 to 20 ml of 0.25% bupivacaine in each block on either side (to maximal dose of 3 mg/kg) and no block in the control patients. Each patient was evaluated postoperatively by a blinded investigator at 2, 4, 6, 12 and 24 h postoperatively. Results: Ultrasound guided abdominal field blocks with 0.25% bupivacaine reduced the total tramadol requirement in the first 24 postoperative hours (157 ± 50.709 vs 386.67 ± 29.16 mg) and also the visual analogue pain scores at 2 (2 vs 8) ,4 (2 vs 8),6 (2 vs 8),12 (4 vs 7) and 24 (4 vs 7) hours postoperatively. No significant difference was found between groups in the incidence of nausea. Sedation was reduced in the patients who received the blocks. There were no complications attributed to the blocks. Conclusion: Ultrasound guided abdominal field blocks, as a part of a multimodal analgesic regimen, provided greater analgesia up to 24 h postoperatively after elective or emergency cesarean delivery.

Page(s): 218-223

DOI: DOI not available

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 21, Issue: 2, Year: 2017

Keywords:

Keywords are not available for this article.

References:

[1] 2006.Caesarean delivery rates and pregnancy outcome: The 2005 WHO global survey on maternal and perinatal health in Latin America,Lancet 367 1819 -29

[2] LiuB,TongC, 2008.Pregnancy i n c r e a s e s e x c i t a b i l i t y o f mechanosensitive afferents innervating the uterine cervix,d o i : 10 108 1087 -92

[3] WoolfCJ, 2004.Pain: moving from symptom control toward mechanism-specific pharmacologic management,Ann Intern Med 140 441 -51

[4] .,DOI: 10.7326/0003-4819-140- 8-200404200-00010 -

[5] SmithR.,Parturition, 2007.,DOI: 10 356 271 -83

[6] UnalER,CiernyJT,RoednerC,NewmanR, 2011.Maternal inflammation in spontaneous term labor,Am J Obstet Gynecol 01 223 -5

[7] FarragherRA,LaffeyJG,ShortenG,CarrD,HarmonD, 2006.P o s t o p e r a t i v e p a i n management: an evidence-based guide to practice,Philidelphia PA: Saunders Elsevier 225 -38

[8] DahlJB,JeppesenIS,JorgensenH,WetterslevJ,MoinicheS. Intraoperative, 1999.and postoperative analgesia efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia: a qualitative and quantitative systemic review of randomized controlled trials,Anesthesiology 91 1919 -27

[9] WerawatganonT,CharuluxanunS.,O I, .(1):CD004088,Cochrane Database Syst Rev 2005 Jan 10 -

[10] FortiadisRJ,BadvieS,WestonMD,Allen-MershTG, 2004.Epidural analgesia in gastrointestinal surgery,Br J Surg 91 828 -41

[11] WittelsB,ScottDT,SinatraRS, 1990.Exogenous opioids in human breast milk and acute neonatal neurobehavior: a preliminary study,Anesthesiology 73 864 -9

[12] McDonnellJG,CurleyG,CarneyJ,BentonA,CostelloJ,MaharajCH,LaffeyJG, f3.The analgesic efficacy of transversus abdominis plane block after caesarean delivery: A randomized c o n t r o l l e d t r i a l,O b s t e t r i c Anesthesiology 0000290294 186 -191

[13] BashandyGMN,ElkholyAHH, .Reducing postoperative opioid consumption by adding an ultrasound guided rectus sheath block to multimodal analgesia for abdominal cancer surgery with midline incision. A n e s t h P a i n M e d . 2 0 1 4 August;4(3):e18263,DOI: 10 -

Citations

Downloads

Views