Efficacy of Intraoperative Trans-peritoneal TAP Block for Post-Cesarean Analgesia: A Randomized Clinical Trial

Background: Most post-abdominal surgery pain comes from the abdominal wall incision. The TAP block is important for multimodal pain relief after cesarean delivery. Aim of the Work: This study aimed to assess if the intraoperative TAP (I-TAP) block effectively reduces opioid use without raising pain scores. Patients and methods: This randomized controlled trial was conducted at Ain Shams University Hospital from January to April 2021, involving 100 women undergoing elective cesarean sections, divided into two groups of 50. Group A (control) received 75 mg of diclofenac sodium and intramuscular pethidine (50 mg) as needed. Group B was treated similarly but included an intra-abdominal anesthetic block. The primary outcome was the mean 24-hour narcotics requirement, while secondary outcomes included postoperative pain at various intervals (2h, 4h, 6h, 8h, 12h, and 24h) measured by a 10-point visual analog scale (VAS) and time to first rescue analgesia. Results: The TAP block group showed a significant reduction in total narcotics administered (5 patients in TAP Block vs. 28 patients in the Control group, P-value: < 0.001; RR: 0.18 (95% CI: 0.08–0.43) and a lower narcotic requirement in TAP vs. control (55.0 ± 11.2 mg vs. 88.4 ± 17.3 mg with a mean difference of 33.4 mg.. Patients reported decreased pain perception (VAS-10) in TAP block versus the control group at rest after 2 hours as follows (0.1 ± 0.3 versus 0.2 ± 0.4, P-value = 0.063), at 4 hours (0.1 ± 0.3 versus 1.8 ± 1.3, P-value < 0.001), at 8 hours (2.0 ± 0.8 versus 4.3 ± 1.0, P-value < 0.001), at 12 hours (2.3 ± 0.5 versus 4.0 ± 0.7, P-value < 0.001), at 24 hours (1.1 ± 0.5 versus1.3 ± 0.6, P-value = 0.070). The main limitation was the increased risk of performance bias as no blinding of participants or surgeons was conducted. Conclusion: The TAP block significantly decreased VAS pain scores. Consequently, there was a notable reduction in the use of narcotics within the TAP block group.