Transversus Abdominis Plane Block Versus Spinal Morphine After Caesarean Section : A Comparison Study

Intrathecal morphine (ITM), administered as a part of spinal anesthesia for caesarian section, can produce significant post-operative analgesia for several hours. The Tranversus Abdominis Plane (TAP) Block can also provide prolonged post-operative pain control. A small number of published studies comparing analgesic outcomes after cesarian section with ITM or TAP block have reported variable results.Moreover, these studies have been conducted in countries with extensive post-operative nursing care.

Many counties in sub-Saharan Africa have very limited post-operative nursing capacity, and relatively little data have been published about post-operative maternal pain control in these settings. Cesarean section is the most common type of major operation at our institution, Mbarara Regional Referral Hospital (MRRH), in south-western Uganda.Nursing ward staffing capacity is low, with much basic nursing care provided by families and friends of patients. The investigators conducted a study to examine the impact of ITM versus TAP block in a setting of limited formal nursing oversight.

Inclusion criteria

• Women between the age of 18-45;
• Greater than 50 kilograms in weight;
• Routine spinal anesthetic without sedation for an uncomplicated caesarean delivery via a low, transverse abdominal incision (Pfannenstiel);
• In good health with no major medical problems including gastric ulcers, liver or renal dysfunction
• Able to communicate freely with a provided non-family member interpreter fluent in the patient's language so that informed consent may be obtained

Exclusion criteria

• Patients with allergies to bupivacaine, paracetamol, or diclofenac;
• Patients undergoing a surgical approach is other than a low, transverse abdominal incision (Pfannenstiel);
• Pre-eclampsia, uterine rupture, placental abruption with this pregnancy;
• Prior complicated abdominal surgery;
• Medical history of gastric ulcers, liver or kidney dysfunction; and
• Patient refusal to be involved in the study. Failure to attain informed consent from the patient due to age or level of consciousness
• Voluntary or involuntary withdraw from the study
• Referral to another health centre or Hospital for further management.