لخّصلي

Abstract
Transversus abdominis plane (TAP) block is an alternative to spinal
morphine for analgesia after Caesarean section but there are few data on its
comparative efficacy.Therefore, we performed a prospective study to
compare the relative analgesic efficacy of TAP block with local anesthetic to
spinal morphine after Caesarean section [7] .The transversus
abdominis 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.6-8 It is a simple and safe technique and is a
potential alterative to spinal opioid for analgesia after Caesarean section,
whether guided by traditional anatomic landmarks or by ultrasound [5].But whether administered systemically or via the spinal nerve,
opioids are often linked to side effects like drowsiness, nausea, and sometimes
even respiratory depression.It has been recommended recently that patients
4
should be monitored extensively to detect respiratory depression5 after
receiving hydrophilic opioids via the spinal route [4] .Pain scores and analgesia requirements were lowest in those receiving spinal
morphine 100 mg. Bilateral TAP blocks using bupivacaine 2 mg kg21had no
extra analgesic effect.The delivery by caesarean section is among the most
often carried out surgical operations.Eighty patients were
randomized to one of four groups to receive (in addition to spinal anaesthesia)
either spinal morphine 100 ug (S(M)) or saline (S(S)) and a postoperative
bilateral TAP block with either bupivacaine (T(LA)) 2 mg kg(-1) or saline
(T(S)).The
rank order of median pain scores on movement at 6 h was: S(M)T(LA) (20
mm) (P<0.05, highest vs lowest).At six hours, the median amount of morphine
consumed was ranked as follows: S(M)T(S) (4.0 mg) mg) with and without spinal morphine after Caesarean section in a prospective,
randomized, double-blinded placebo-controlled trial.SM, spinal morphine; SS, spinal saline; TS, transversus
abdominis plane block with saline; T LA, transversus abdominis plane block with local anesthetic.Although the best kind of postoperative analgesia is unknown, patients
usually get spinal, systemic, or both opioids as part of multimodal analgesia in
the postoperative phase, since many procedures are performed under spinal
anesthesia [3] .13-16 However, there are few studies comparing TAP block with spinal
opioids or with epidural analgesia TAP block would have the benefit of better
analgesia, a decrease in opioid-associated side effects, and the lack of spinal
opioids if it were superior.Additionally, compared to
systemic opioids, local anesthetic-based techniques may offer similar resting
analgesia but better analgesia during movement and may even work in concert
with neuraxial opioids [6] .Pain on movement and early morphine consumption were lowest in
groups receiving spinal morphine and was not improved by TAP block.SM, spinal morphine; S S, spinal saline; T LA, transversus
abdominis plane block with local anaesthetic; TS, transversus abdominis plane block with saline.Spinal morphine plus TAP block with bupivacaine 2 mg
kg(-1) did not result in any more analgesic improvement.Caesarean rates as high as 31.9% have been documented in the UK in 20082,
and it's estimated that over a million are performed each year in the USA
alone.(iii) To determine whether a TAP block, when administered in
addition to spinal morphine, provided any incremental benefit .Introduction :
Transversus abdominis plane (TAP) blocks are increasingly used for
analgesia after abdominal surgery.This study assessed whether TAP blocks
provide additional analgesia to spinal morphine after Caesarean section[1].9-12 It
has been shown to be effective in Caesarean section and after hysterectomy,
open prostatectomy, laparoscopic cholecystectomy, and appendicectomy.The
S(M)T(LA) group exhibited the highest levels of pruritus and antiemetic
usage.Following a Caesarean operation, spinal morphine increased analgesia
but not TAP block.We hypothesized that a TAP block with local anesthetic would result in less
pain on movement than spinal
morphine at 6 h after operation.and the following values were
recorded after 24 hours: S(M)T(LA) (5.0 mg) (9.5 mg) difference in patient satisfaction or sedation scores between the groups.3
fig 1:Interval morphine consumption.15% of births worldwide and 21.1% of
births in the developed world are thought to occur by Caesarean section [2].Aims of study :
our aims were :
(i) To determine the analgesic efficacy of TAP block.*P,0.05 vs S S TS. + P,0.05 vs SST LA. + P,0.05 vs S M T LA.
1.1.Thus, knowledge
about alternative (non-opioid) analgesia is important.(ii) To compare TAP block to spinal morphine .Motor blockage.5
2.1.