Ultrasound-Guided TAP Block with Intrathecal Morphine versus Intrathecal Morphine Alone for Post-Cesarean Pain incidence and Control among Elective Patients done under Spinal Anesthesia: A Cohort Study at TASH, Addis Ababa, Ethiopia, 2023.
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Date
2023-05
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Addis Ababa University
Abstract
Background:About 80% parturient reported post C/D pain. Quality pain optimization is a priority in
women undergoing C/D. Unmanaged perioperative pain results greater opioid use, delayed
recovery, impaired feto-maternal bonding, and increased blue and depression.
Despite multimodal analgesia is the core principle for cesarean delivery pain management,
the combination of ultrasound-guided TAP block with intrathecal morphine versus intrathecal
morphine alone is a bit controversial.
Objective: This study was aimed to assess the effectiveness of ultrasound-guided transversus
abdominis plane block with intrathecal morphine versus intrathecal morphine alone for post-
C/D pain control among elective patients done under spinal anesthesia at TASH.
Method: A hospital-based prospective cohort survey was conducted among a total of 48
patients. Data was collected using a structured questionnaire. Data was entered, coded and
analyzed by using SPSS V. 25. A descriptive analysis was done for the Socio-demographic data.
After checking for Normality and Homogeneity of the data, parametric and nonparametric
comparative analysis, was done. Chi square test was conducted to measure association
between categorical variables. A statistical significance was declared with p-value ≤ 0.05.
Result:The Mann-Whitney U test was performed to compare postoperative pain intensity at rest or
during movement between TAP group and ITM group. There was statistically significant
difference in NRS at 2hrs post-operative time between TAP group (Median = 0, IQR = 0) and
ITM group (Median =0, IQR = 2), U = 210.5, z = 1.95, p =0.05. The effect size(r) was calculated
as r = 0.3. Similarly, in the 6 and 12 hrs postoperatively, TAP group median (IQR) vs ITM
median (IQR), U, z, r and (p-value) were 0(1) vs. 4 (2), 0, 6.12, 0.67 and (p < 0.001), 1 (0) vs. 3
(1), 68, 4.67, 0.67 and (p < 0.001) respectively
The Mann-Whitney U test was performed and showed there was a statistically significant
difference in first analgesic request time between TAP (Median = 15, IQR = 12 - 18) and ITM groups
Out of the 24 patients in the TAP group, 2 reported experiencing NRS pain score of ≥4 at
rest within 24 hours postoperatively, resulting in a pain incidence of 8%. In the ITM group, 22
out of 24 patients reported NRS pain score of ≥4 at rest within 24 hours, resulting in a pain
incidence of 92 %
Conclusion and recommendations:In this study combining TAP block with intrathecal morphine
has better post cesarean deliverypain control. First analgesics request by the TAP group was
longer (15 hr vs 5 hrs for intrathecalalone).The overall incidence of moderate to severe
post cesarean delivery pain at rest for theunexposed group was 92%vs 8% for exposed group.
From this study anesthesia providers have to focus on multimodal approach of post cesarean
delivery pain management. Combining regional technique with systemic analgesics
significantly reduces pain burden in postoperative periods. Utilization of ultrasound for TAP
block is strongly advised to reduce complications and optimize effectiveness.
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Keywords
Transversus Abdominis Plane Block, Intrathecal Morphine, Cohort Study, Ethiopia.