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.
