Transversus Abdominis Plane (TAP) Block using Bupivacaine versus Bupivacaine with Magnesium Sulfate for Post-Caesarean Section Pain Control

Abstract

Proper post-operative pain control following caesarean section can significantly improve wellbeing of mothers and newborns in the early post-partum period. Inadequately controlled pain can impair functions such as ambulation, dietary intake, breastfeeding and early maternal bonding with the infant. Poor pain control can also lead to decreased level of satisfaction, prolonged recovery and higher health care cost. Transversus abdominis plane block is a technique for effective pain control following caesarean section that significantly lowers post-operative analgesics consumption and enhances early function recovery and surgical outcomes. Different drug combinations have been explored to determine the most efficient analgesic combination that achieves an optimal nerve blockade with fewer side effects. In our study we evaluated Magnesium Sulfate as an adjuvant to Bupivacaine which is frequently used as a local anesthetic in TAP block. Addition of Magnesium Sulfate has been found to enhance the effect of local anesthetic and prolongs its duration of action. The primary aim of the study is to assess the time interval after which there was a requirement of first supplemental dose of analgesia. Secondary objective is to assess the duration of hospital stay, patient satisfaction (assessed by VAS score), time to first bowl movement (audible sounds, passing flatus), mobilization initiation time, breastfeeding initiation time, total dose of rescue analgesia given in first 24 hours post-operative and post-operative side effects. To achieve our goals, we randomly selected 92 women between 20 and 40 years who are scheduled for elective caesarean section under spinal anesthesia with no medical illness. We conducted the study in Ain Shams University Hospitals after approval of the medical ethical committee.