Bupivacaine in transverses abdominis plane block for post cesarean section either blindly or ultrasound guided

Study objective To compare the effectiveness of blind transverses abdominis plane (TAP) block versus ultrasound-guided TAP block for pain relief after a cesarean section. Background For decades, postoperative analgesia for cesarean deliveries was either systemic drugs, with their adverse effects such as nausea, or epidural analgesia, which would hinder ambulation. The TAP block was introduced by Rafi . It is a novel technique in which blockade of the sensory nerves to the anterior abdominal wall is performed by a regional anesthetic. This is a regional analgesic technique that blocks T6–L1 nerve branches and is increasingly playing a role in postoperative analgesia for lower abdominal surgeries. Patients and methods Sixty American Society of Anesthesiology I and II multiparous pregnant women aged 25 and 30 years old with BMI between 20 and 25 kg/m^2 planned for elective cesarean section (CS) at 38 weeks were allocated randomly to two groups of 30 patients each. Group B received bupivacaine 2 mg/kg of 0.375% solution per side to a maximum dose of 150 mg landmark guided. Group U received bupivacaine 2 mg/kg of 0.375% solution per side to a maximum dose of 150 mg ultrasound guided. Postoperatively, women were asked to document the degree of pain they experienced at 30 min, 1-, 4-, 6-, and 12-h periods. Printed copies of the visual analogue scale ( VAS) between ‘no pain’ (0) and ‘very severe pain’ (100 mm) were given to patients and they were taught how to fill them. We assessed the patient clinically for pain and prescribed pethidine 100 mg intramuscularly if the patient complained of severe pain (VAS 60 mm). The time of analgesia was documented in the patient’s form. Any local complications of the TAP block were also recorded.