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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)<S(M)T(S) (27.5 mm)<S(S)T(S) (51.5 mm)<S(S)T(LA) (52.0 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)<S(M)T(LA) (5.0 mg)<S(S)T(LA) (8.0 mg)<S(S)T(S) (12.0 mg).We compared the analgesic efficacy of the TAP block 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)<S(M)T(S) (6.0 mg)<S(S)T(S) (9.5 mg)<S(S)T(LA) (15.0 mg) (P<0.05, greatest versus lowest).There was no 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.

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. We compared the analgesic efficacy of the TAP block
with and without spinal morphine after Caesarean section in a prospective,
randomized, double-blinded placebo-controlled trial. Eighty patients were
randomized to one of four groups to receive (in addition to spinal anaesthesia)
either spinal morphine 100 µg (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)). Pain on movement and early morphine consumption were lowest in
groups receiving spinal morphine and was not improved by TAP block. The
rank order of median pain scores on movement at 6 h was: S(M)T(LA) (20
mm)