POSTOPERATIVE PAIN RELIEF IN CAESAREAN SECTION: A COMPARATIVE STUDY OF TRANSVERSALIS FASCIA PLANE BLOCK, QUADRATUS LUMBORUM BLOCK AND ILIOINGUINAL ILIOHYPOGASTRIC NERVE BLOCK.
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Abstract
BACKGROUND:
Caesarean delivery is the most commonly performed abdominal surgery in the world, and it can be associated with severe postoperative pain.Poor postoperative pain control may delay functional recovery, impair mother–baby interaction, complicate breastfeeding, delays mobilisation and increase the risk of persistent postsurgical pain. Current practices for post-cesarean delivery analgesia include neuraxial opioids and/or local anaesthetics and nonopioid analgesics, such as nonsteroidal anti-inflammatory drugs and acetaminophen, regional blocks1.
KEY WORDS: Quadratus lumborum (QL) block,Transversalis fascia plane block(TFPB),(ILIH) Ilioinguinal-Iliohypogastric Nerve Block, VAS and dynamic VAS.
OBJECTIVE:
This study aims to compare analgesic efficacy of transversalis fascial plane block (TFPB) vs quadratus lumborum block (QLB) vs Ilioinguinal Iliohypogastric (ILIH) block in women undergoing caesarean section under neuraxial anesthesia.
MATERIALS AND METHODS:
An observational single blinded study was done on 90 parturients who were divided into 3 groups - T,Q,I of 30 each. Group T received transversalis fascial plane block (TFPB),Group Q received quadratus lumborum block (QLB), Group I received Ilioinguinal Iliohypogastric (ILIH) block with 0.25% levobupivacaine and 8 mg dexamethasone - 30ml on right and left side.
RESULTS:
- The total analgesic demand in the first 24h was reduced in the Quadratus lumborum(QL) group(0.74 ± 24)compared to that of the Transversalis fascia plane block(TFPB) group and (ILIH) Ilioinguinal-Iliohypogastric Nerve Block group. The patient's postoperative resting and dynamic VAS ratings were similar, except for the first hour ratings.
- QL had prolonged analgesic effect at 24hrs when compared to TFPB and ILIH block with an effect lasting for 19-24hrs. The mean±standard deviation of time for first analgesic request for QL block was (21.28 ± 46) hrs, TFPB (20.1±2.28) hrs, ILIH (16.57±2.45) hrs.
CONCLUSION: The three blocks- ILIH, TFPB, QL block provide reliable postoperative analgesia after caesarean section,but the QL block provides prolonged and better quality of analgesia compared to other two blocks.
References
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Dr. Vadlamudi Venkateshwara Rao
Assistant Professor, Narayana Medical College, Nellore, Andhra Pradesh, India
Dr.A. Rajitha
Assistant Professor, Narayana Medical College, Nellore, Andhra Pradesh, India
Dr. Gunapati Chaitanya Kumar
Associate professor, Narayana Medical College, Nellore, Andhra Pradesh, India
Dr. Kuruva Jayasree
postgraduate, Narayana Medical College, Nellore, Andhra Pradesh, India
Dr. Ravulapalli Harish Babu
Professor Narayana Medical College, Nellore, Andhra Pradesh, India
Dr. Kandukuru Krishna Chaitanya
Professor Narayana Medical College, Nellore, Andhra Pradesh, India