Abstract
Author(s): Khaled M. Alanwer*, Ahmed Alaa Eldin Wali, Mohamed Abdo, Ezz F. Ismail, Bahaa G Mohamed
Background and aim: Intrathecal morphine is the gold standard for postcesarean analgesia, with the Transversus Abdominis Plane (TAP) block being a key alternative when contraindicated; however, the optimal timing for TAP block administration remains uncertain. This study compared preoperative vs. postoperative TAP block in 223 patients undergoing elective cesarean delivery under spinal anesthesia. Patients and methods: This study is a comparative clinical trial, conducted at Saudi German Hospital from January 1, 2021, to January 5, 2022, following institutional ethical approval [ECC 2021-06]. The study enrolled 248 ASA II parturients were randomized, and 223 were included in the final analysis for primary outcomes. Participants were assigned to receive either a preoperative (n=110) or postoperative (n=113) ultrasound-guided TAP block with 0.25% bupivacaine. Primary outcomes were 24-hour opioid consumption and pain scores at rest and movement assessed at 2, 4, 6, 8, 12, and 24 hours postoperatively using a Visual Analog Scale (VAS). Results: The two groups were demographically comparable. No statistically significant differences were found in 24-hour meperidine consumption (preop 78.5 mg vs. postop 82.4 mg, p=0.301) or in VAS pain scores at any time point at rest or during movement (all p>0.05). The time to first analgesic request was also similar between groups (7.8h vs. 7.2h, p=0.187). However, the preoperative block was performed significantly faster (108.5s vs. 135.2s, p<0.001) and at a shallower depth (2.05 cm vs. 2.55 cm, p<0.001). Conclusion: Preoperative and postoperative TAP blocks provide equivalent analgesia, offering clinicians flexibility in timing based on logistical preference.