A Comparative Study of the Analgesic Efficacy of Transversus Abdominis Plane Block Alone Versus Transversus Abdominis Plane Block and Diclofenac Suppository in the Management of Post Caesarean Section Pain

Abstract

Background: Post caesarean delivery pain has both visceral and somatic components. Transversus abdominis plane (TAP) block which affects  mainly the somatic component has been used to manage post caesarean section pain. The addition of diclofenac suppository which affects both  visceral and somatic component could provide better analgesia.

Objective: To determine if a combination of TAP block and diclofenac suppository will improve the quality of post caesarean section analgesia.

Patients and Methods: Ninety pregnant women with American Society of Anaesthesiologist (ASA) physical status class I or II scheduled for elective  caesarean section under subarachnoid block (SAB) were randomly assigned to 2 groups of 45 each, to receive either bilateral transversus abdominis  plane block alone or bilateral transversus abdominis plane block and 200mg of diclofenac suppository postoperatively.

Results: The time to first request for analgesia was more than three times longer for the TAP block/rectal diclofenac group (332.71±96.70 min) when  compared to the TAP block group (104.07±79.67 min, P = 0.001). The mean pethidine consumption was 215.56±56.23 mg in the TAP  block/rectal diclofenac group and 319.51±55.77 mg (P=0.001) for TAP block group. The proportion of patients who strongly agree to a satisfactory  pain management on Likert's scale was 60.0% in the TAP block/diclofenac suppository group compared to 11.1% (P=0.001) in the TAP block group. 

Conclusion: Co-administration of diclofenac suppository and transversus abdominis plane block improved the quality of analgesia for post caesarean section pain.