Clinical Comparative Study Between Subcutaneous Continuous Analgesia Versus Continuous Transversus Abdominis Plane Block Post Cesarean Section

Background: A Cesarean section (CS) involves making an incision in the uterus and an open abdominal incision to deliver the fetus. Reduced surgical stress response, more patient satisfaction, and better results are all facilitated by effective postoperative analgesia. The transversus abdominis plane (TAP) block provides for sensory blockage of the lower abdominal wall by depositing local anesthetic between the internal oblique and transverse abdominis.
Objective: This study aimed to compare subcutaneous continuous analgesia (CSA) with continuous TAP block after Caesarean section delivery.
Patients and methods: A clinical trial study was conducted on 100 patients according to the American Society of Anesthesiologists (ASA) physical status I or II in The Obstetrics and Gynecology Department in Shebin El-Kom Teaching Hospital & Menoufia University Hospital during the study period from March 2023 to June 2024.
Results: There was no significant difference between the studied groups regarding ASA I and ASA II (P>0.05). There was no significant difference among the studied groups regarding VAS at movement after 2 hrs, (P > 0.05). VAS at movement after 4 hrs was significantly higher among continuous wound infiltration (2.38 ± 1.41) than continuous bilateral transversus abdominis plane (1.27 ± 0.79), (P < 0.05). VAS at movement after 8 hrs was significantly higher among continuous wound infiltration (2.92±1.58) than continuous bilateral transversus abdominis plane (2.04 ±1.57), (P<0.05). Nausea was significantly more common among continuous wound infiltration (n=12, 24.0%) than in continuous bilateral transversus abdominis plane. Nausea and itching and vomiting were significantly common among continuous bilateral TAP.
Conclusion: The TAP block, with its ability to deliver targeted regional analgesia, demonstrated superior outcomes in terms of prolonged pain relief, reduced systemic side effects, and enhanced patient mobility during the post-operative period. The technique was associated with fewer complications and was particularly effective in reducing opioid consumption compared to CSA.