Abstract:
Abstract
Background: Caesarean delivery can be associated with considerable postoperative pain.
While the benefits of transversus abdominis plane (TAP) and ilioinguinal-iliohypogastric (II-IH)
nerve blocks on pain after caesarean delivery via Pfannenstiel incision has been demonstrated, no
enough investigations on the comparison of these blocks on pain after caesarean delivery have
been conducted. We tested the hypothesis that both blocks reduce pain scores, decrease opioid
consumption and prolong analgesic request time after caesarean delivery.
Methods: A total of 102 participants were included in the study, 51 in the TAP group and 51 in
the II-IH group.Institutional based prospective observational cohort study was conducted to
compare the analgesic efficacy of those blocks. The outcome measure was severity of pain
measured using numeric rating scale of 0-10 at 0, 4, 6, 8, 12 and 24 hours, total opioid
consumption and first analgesic request time during the first postoperative 24 hrs.
Result: Twenty four hours after surgery NRS at rest was (0.90±0.80) vs (0.67±0.58) and at
movement (1.2±1.07) vs (0.88±0.76) for the TAP and II-IH groups respectively. The difference
between the groups over the whole observation period was not statistically significant (P>0.05).
Twenty-four hours after surgery, (mean ±SD), cumulative tramadol consumption was
(55.45±30.51) vs (37.27±27.09) mg in TAP and II-IH groups respectively (p= 0.009).
The (mean ±SD) first analgesic requirement time was also prolonged in the II-IH group in
stastically significant fashion (p = 0.03).
Conclusion and recommendations: There was no stastically significant difference
between TAP and II-IH nerve blocks regarding post operative pain score in each time point both
at rest and at movement but II-IH block significantly reduced total tramadol consumption and
prolong time to first analgesic request than TAP.
We recommend II-IH nerve block for post cesarean delivery pain management via Pfannenstiel
incision.
Key words: Caesarean Delivery, Ilioinguinal Nerve, Iliohypogastric Nerve, Transversus
abdominis plane block, Gondar, Ethiopi
