Transversus Abdominis Plane Block Versus Spinal Morphine After Caesarean Section : A Comparison Study
Condition: Pregnancy, Ceasarian Section, Anaesthesia
Study type: Interventional
Phase: Phase 3

Summary: 
      Many counties in sub-Saharan Africa have very limited post-operative nursing capacity, and
      relatively little data have been published about post-operative maternal pain control in
      these settings. Cesarean section is the most common type of major operation at our
      institution, Mbarara Regional Referral Hospital (MRRH), in south-western Uganda.Nursing ward
      staffing capacity is low, with much basic nursing care provided by families and friends of
      patients. The investigators conducted a study to examine the impact of ITM versus TAP block
      in a setting of limited formal nursing oversight.
    

Detailed description: 
      Intrathecal morphine (ITM), administered as a part of spinal anesthesia for caesarian
      section, can produce significant post-operative analgesia for several hours. The Tranversus
      Abdominis Plane (TAP) Block can also provide prolonged post-operative pain control. A small
      number of published studies comparing analgesic outcomes after cesarian section with ITM or
      TAP block have reported variable results.Moreover, these studies have been conducted in
      countries with extensive post-operative nursing care.

      Many counties in sub-Saharan Africa have very limited post-operative nursing capacity, and
      relatively little data have been published about post-operative maternal pain control in
      these settings. Cesarean section is the most common type of major operation at our
      institution, Mbarara Regional Referral Hospital (MRRH), in south-western Uganda.Nursing ward
      staffing capacity is low, with much basic nursing care provided by families and friends of
      patients. The investigators conducted a study to examine the impact of ITM versus TAP block
      in a setting of limited formal nursing oversight.
    

Intervention name(s): Intrathecal morphine
Intervention type(s): Drug
Intervention description(s): ITM group were given 100 micrograms of preservative-free morphine in addition to the local anaesthesia (plain hyperbaric bupivacaine 10mgs) intrathecally during the spinal anaesthesia
Other intervention name(s): Intrathecal
Intervention MeSH terms: Morphine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The patients in the intrathecal morphine (ITM group) were given a sham block, while the patients in the TAP group were given a TAP block. Sham blocks consisted of a non-invasive ultrasound scan. A blunt needle was gently pressed on either side of the abdomen. Bilateral TAP blocks were placed after ultrasound location of the transversus abdominis and internal oblique muscles, with the injection sites in the Triangle of Petit located at the lateral edge of the mid-abdomen. Following negative aspiration for blood, the local anaesthetic (0.25% bupivacaine with 1:200000 epinephrine) was injected in the transversus abdominis plane under ultrasound visualization in 5 cc aliquots for a total volume of 15cc per side.
Masking: Single (Participant)
Primary purpose: Treatment