Efficacy of Trans-Abdominis Plane Block for Post Cesarean Delivery Analgesia in Low-Income Countries: A Phase Three Feasibility Study

Efficacy of Trans-Abdominis Plane Block for Cesarean Delivery Analgesia in Low-Income Countries: A Phase Three Feasibility Study. Journal 553-564. Abstract Background: Optimal pain control in a parturient woman undergoing caesarean section is essential for preventing complications and improving maternal satisfaction, early functional recovery, mother-baby bond and breastfeeding. Intentional pain assessment and adequate management to acceptable pain severity two groups 41 (interventional group) and 31 (Control). Interventional received 30ml 0.25% bupivacaine in each side for postoperative analgesia and Control, which was treated by the hospital pain management approach. Patients randomization and demographic were recorded before surgery, then were assessed for numeric pain score at rest and, on physical activities also patients, satisfaction at 0hrs, 6hrs, 12hrs and 24hrs. Results: Total of 72 patients were analyzed with pain score at 0hr, 6hr and 12hr. It was significantly low by about 50% with p-value (2 tail) of < 0.001 however at 24 hrs. was 0.272. And also had improved movement 0hr, 6hrs and 12hrs with p-value <0.001 as compare to control which was limited though was not significant in coughing. Satisfaction with pain management was 95.1% with no reported adverse event. Conclusions: Trans Abdominis Plane block when used as part of multimodal is an effective in managing postoperative pain with less physical limitation and high patients’ satisfaction in post caesarean section.


Background
Caesarean section has been increasing worldwide, approximately 18.5 million are done annually. On average, at KCMC there are 13 deliveries a day, 49.2% are by C/S. With a gift of a baby(s) she needs to be alert, comfortable and have early functional recovery.
However, Pain is one of the immediate outcomes postoperatively with prevalence of > 78.4% (moderate to severe) [1][2][3]. When pain is not treated the following will be complication delay ambulation, increased risk of thromboembolic event, delayed wound healing, hemorrhages, stress, complicated hypertension and myocardial ischemia, shallow breathing -hypoxia, hypercarbia and respiratory infections. As consequence to child will reduce mother-child bond, difficulty breastfeeding (irritability, hypoglycemia and jaundice

Primary outcomes:
Primary outcome was the pain score, which was assessed by using numerical rating scale (NRS) and function assessment by using pain scores on physical activities such as turning in bed, sitting, standing, walking and coughing. Patients were asked to rate the intensity of pain out of ten using NRS. It a 10-point numerical rating scale with end points representing the extremes of the pain experience: 0 = "no pain at all" and 10 = "worst possible pain". The score was classified as mild pain when the score is 0 to 3, moderate pain when the score is 4 to 7 and severe pain when the score is 8 to 10 It is difficult to assess pain objectively, although it can be assessed at rest and during movement by NRS to detect changes and difference in pain scores.
Functional assessment was assessed by functional activity including turning in bed, sitting, standing and walking was marked on a numeric rating scale ranging from zero = "no pain" to 10 = "maximum pain" [9].

Results
A total of 72 participants met the criteria were recruited. 12 participants were removed as 3 did not wish to continue. 3 were sent to ICU after surgery of obesity, 4 with hemodynamic instability and 2 participants didn't visualize layer to identify transversus abdominis plane to deposit local anesthetics. Thus 41 were in TAP group and 31 in nonintervened.    Table 2: Pain score at 0hr, 6hrs, 12hrs and 24 at rest  Table 3: Pain score at 0hr, 6hrs, 12hrs and 24 on physical movement

Patients' satisfaction
Patients' satisfaction was categorized into 3-point

Discussion
Caesarean section is increasing significantly more recently, pain post-operative being among immediate consequence. Pain management after CS is aiming at conferring maternal comfort, no side effect to mother and a born child and early recuperate to normal function to help a new born baby. However, there is a challenge in achieving this due to fact that is associated with lots of poor pain control, nausea and vomiting.
Local regional technique such as TAP have been studied and compared to other techniques to incorporate as component in multimodal pain management approach proved efficacious.

Pain score at rest
The

Conclusion
This study observed the analgesic benefit of TAP

Consent for publication
Not applicable

Availability of data and materials
The data set is with personal investigator it will be proved if necessarily needed.

Conflicts of interest
Am declaring there is no conflicts of interest

Funding
This work was self-funded. Reviewed manuscript edited corrected.