Comparison of Postoperative Analgesia with Transversus Abdominis Plane(TAP) Block versus Local Infiltration with Ropivacaine and Dexmedetomidine in Elective Caesarean Section under Spinal Anaesthesia

Background: Effective pain control in the postoperative period in elective lower segment cesarean sections is essential for enhancing maternal recovery, breastfeeding, and bonding. Our study compares Transversus Abdominis plane (TAP) block with local anesthesia infiltration for the same, and provides valuable insights into which method offers better pain relief, reduced opioid consumption, and improved hemodynamic stability.

Methodology: This observational study was conducted in the Department of Anaesthesiology in a superspeciality medical college hospital involving 70 patients undergoing elective caesarean sections under spinal anaesthesia. Patients were divided into two groups : one received local infiltration with 0.2% Ropivacaine 20ml and 50mcg Dexmedetomidine (Group I), while the other received a TAP block (Group II) with 0.2% Ropivacaine 20ml and 50mcg Dexmedetomidine. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at various intervals, and the requirement for rescue analgesia with Fentanyl, hemodynamic parameters and adverse effects were documented. Observational descriptive stastistics, parametric and non-parametric tests were used as applicable.

Results: Significant differences were observed in pain management outcomes, with Group I reporting higher Visual Analog Scale (VAS) pain scores at 4, 6, and 8 hours post-procedure, while Group II exhibited higher scores at 12 hours (p < 0.05). Group I had higher heart rate upto 8hours postoperatively (p =0.002).Group I had higher Systolic Blood Pressure (SBP) at 2,4,8 hours postoperatively ( p value is 0.012).Group I had higher Diastolic Blood Pressure (DBP) at 2hours while Group II had higher DBP only after 10minutes.Group I had more adverse effects compared to Group II .Additionally, Group I showed higher incidence of the need for  Fentanyl rescue opioids at 6 and 8 hours postoperatively (p < 0.05) and needed their first dose of rescue opioids considerably earlier than Group II (p < 0.001). Furthermore, the cumulative dose of Fentanyl administered was significantly greater in Group I compared to Group II.

Conclusion: The TAP block group demonstrated lower pain scores, reduced opioid consumption, better hemodynamic stability, and fewer adverse effects, making it a more effective and safer option for postoperative analgesia , compared to the local anesthesia infiltration group.