Journal of Anesthesia & Critical Care: Open Access Efficacy of Transversus Abdominis Plane (TAP) Block as Part of Multimodal Analgesia after Cesarean Section Delivery Volume 3 Issue 3 - 2015 Fentahun Tarekegn 1 *, Setegn Eshetie 2 and Kassaw Moges 3 1 Department of Anesthesia, Debre Tabore University, Ethiopia 2 Department of Microbiology, University of Gondar, Ethiopia 3 Department of Anesthesia, Bahir Dar University, Ethiopia *Corresponding author: Fentahun Tarekegn, Department of Anesthesia, Debre Tabore University, Ethiopia, Tel: +251913824072; Email: Received: October 10, 2015 | Published: November 12, 2015 Submit Manuscript | http://medcraveonline.com J Anesth Crit Care Open Access 2015, 3(2): 00100 Introduction Cesarean section (CS) is the Universal surgical procedure which accounts 15 % of birth world wide and 21.1 % in the developed countries [1]. Similarly, it is the common practice in our hospital, Ethiopia. The pain after surgery is experienced by means of patients below umbilicus surgery which derives from the abdominal wall incision [2]. Transversus abdominis plan (TAP) block is the thriving regional analgesia practice for postoperative pain management with significant outcome on assisting infant care, early ambulation, and hindrance of postoperative morbidity [3]. Opioids and non steroidal anti inflammatory drugs are regular postoperative pain relief in our setup. However, systemically administered opioids are causing adverse effects of sedation, nausea, vomiting, urinary retention, respiratory depression, delayed recovery, and prolonged postoperative ileus [4,5]. On the other hand, TAP block analgesic technique can lower severity of pain, nausea and vomiting and paralytic ileus at post operative period. It is also having in reduction of postoperative morbidity, duration of hospitalization and hospital costs [6]. Even though, the epidural patient-controlled analgesia (PCA) is given through a catheter placed into the epidural space, it has a chance of serious complications of epidural abscess, meningitis, vertebral canal hematoma, spinal cord ischemia and paraplegia [7,8]. Studies showed on the TAP block which has been implemented to minimize systemic opioid drug complications as well as management of the postoperative pain effectively [9-12]. TAP is a new, rapidly expanding regional anesthesia technique that provides analgesia to the parietal part of peritoneum as well as the skin and muscles of the anterior abdominal wall [13,14]. It involves a single large bolus injection of local anesthetic into TAP anatomical compartment to block somatic afferent nerves on the anterior abdominal wall of T7 to L1 dermatomes [2,10,15]. Research Article Abstract Background: Patients after Cesarean Section go through post operative pain. Most of this pain is experienced after the abdominal wall incision. Transversus abdominis plan (TAP) block as part of multimodal analgesia is a novel approach for patients delivered by cesarean section (CS). This technique (TAP block) lends itself particularly well to resource-poor settings as it does not require a nerve- stimulator. The aim of this study was to evaluate the efficacy of transversus abdominis plane (TAP) block when it is used as part of multimodal analgesia on obstetric patients after Cesarean Section. Methods: Institution based prospective cohort study design was conducted on patients, who have Cesarean Section from February to May, 2015. All patients operated under spinal anesthesia for cesarean delivery were included. Patients divided into TAP block (n=20) and controls (n=20). The TAP block group was given bilateral 20 ml of 0.25% bupivacaine at the end of surgery. Postoperative pain was assessed within the first 24 hours i.e. at 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours using 100 mm long visual analogue scale (VAS), total analgesic consumption and time for the first analgesic request. Result: There was reduction of VAS scores within the first 24 hours after cesarean section in TAP block group compared with the control group. VAS scores as median(IQR) at 2 hours 0.00(0.00-11.50) vs 39.00(7.75-60.50), p=0.001, at 4 hours 0.00(0.00–12.75) vs 17.50(13.25-24.00), p=0.000, at 6 hours 9.00(1.50- 12.00) vs 22.00(14.75-45.00), p=0.000, at 12hours 13.00(11.00-16.00) vs 42.00(10.00-52.00), p=0.003, at 24 hours 10.00(8.00-12.00) vs 15.50(11.25- 26.00), p=0.013 respectively. The total analgesic Tramadol consumption within 24 hours was reduced in TAP block group, and time for the first analgesic request was significantly prolonged (286.00 vs 76.25, p=0.000) minutes. Conclusion: Bilateral TAP block provides lower postoperative severity of pain, reduced total postoperative Tramadol analgesics consumption and prolonged time for the first analgesic request after cesarean section under spinal anesthesia when it is used as multimodal analgesia. We recommend TAP block should be included as part of multimodal analgesia in the postoperative period for women after Cesarean Section delivery. Keywords: Cesarean Section; Transversus abdominis plane block; postoperative analgesia; Spinal anaesthesia