Effect of TAP Block on Time Required for First Analgesic Dose After Cesarean Cection Under Spinal Anesthesia
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional
Phase: Phase 2

Summary: 
      While opioids are the mainstay for post-operative analgesia after caesarean section, they are
      associated with various side effects. Ultrasound guided transversusabdominis plane (TAP)
      block has been postulated to provide effective analgesia for caesarean section. However a new
      technique in TAP block is described which can be used safely by a beginner without any fear
      of complication whichwill help in providing good postoperative analgesia to maximumnumber of
      patients.

      This study will evaluate the analgesic efficacy of TAP block using Modified Surgeon Assisted
      Bilateral TAP block for post caesarean analgesia in a randomized controlled trial.
    

Detailed description: 
      Acute severe pain after cesarean delivery is frequent. At least 10 to 15% of the women
      develop chronic pain .Effective postoperative analgesia after caesarean section is important
      because it enables early ambulation and facilitates breast-feeding.

      The administration of opioids, local blocks and other analgesic medication is instituted to
      decrease the duration and intensity of postoperative pain as a part of a multimodal analgesic
      regimen. The transversusabdominis plane (TAP) block is a regional analgesic technique which
      blocks T6-L1 nerve branches and has an evolving role in postoperative analgesia for lower
      abdominal surgeries .

      In postoperative analgesia, efficacy of TAP block is equivalent to morphine with the
      additional benefits of increasing duration of analgesia, reducing postoperative opioid usage,
      with satisfactory pain relief and few side effects.

      The TAP block avoids the risk of neuraxial complications and opioid complications in all
      patients. TAP block the neural afferents of theanterior abdominal wall after spreading of the
      local anesthetic agent in the neurofascial plan between the internal oblique and
      transversusabdominis muscle.

      TAP block has been underutilized in spite of having very low complication and high success
      rate using ultrasound technique This may be due to the lack of availability of ultrasound at
      most of the centers, lack of training in ultrasound guided block technique.

      A new technique can be used in TAP block without the fear of complications in the blind
      landmark based approach.The advantage of this technique includes avoiding missing the second
      pop in obese and pregnant patients due to thinning of the internal obliqueaponeurosis,
      reposition of the needle by surgeon if one enters the peritoneal cavity accidentally. Also
      there are nil chances of visceral injury thus can be safely used by a beginner without any
      fear of complication. However, there might be a chance of needle stick injury to the
      surgeon's hand.

      This study aims to evaluate effect of the Modified Surgeon Assisted Bilateral TAP block on
      time required for first analgesic dose after Cesarean Section under spinal anesthesia
    

Intervention name(s): Transversus abdominus plane block; Transversus abdominus plane placebo
Intervention type(s): Drug; Drug
Intervention description(s): transversus abdominus plane block using 40 ml of bupivacaine 0.25%; injection of 40 ml of normal saline in the transversus abdominus plane
Other intervention name(s): Regional analgesia
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Prevention