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465: Ultrasound Guided Transversus Abdominis Plane [TAP] Block for Caesarean Sections
130
Posters
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Obstetrics
415. Fetal and maternal outcome after control of maternal blood pressure during cesarean section under spinal anaesthesia: comparison of three vasopressors K. Jain, N. Bharadwaj PGIMER, Anaesthesia and Intensive Care, Chandigarh, India Background and Aims: Maintaining systolic blood pressure at 100% of baseline is best for fetal and maternal outcome. We hypothesized that irrespective of the vasopressors used, maintaining SBP at 100% of baseline with phenylephrine (P), Metraminol (M) or ephedrine (E) will produce the best fetal ph after cesarean section under subarachnoid block. Methods: Ninety ASA1 women scheduled for elective LSCS were randomly allocated to receive P, M or E. SAB block was established with patient in left lateral position using 2.5 cc of 0.5% hyper baric bupivacaine. Immediately following SAB, patients received a bolus of the study drug (E⫽2.5mg, M⫽0.25 mg, P⫽30 g) followed by infusions (E⫽ 5 mg/min, P⫽60 g/min, M⫽0.5 mg/min) to maintain SBP at 100 % baseline till delivery of the baby. Umbilical blood gases, maternal Haemodynamic parameters and complications were recorded. Results: The umbilical pH was comparable in all three groups (p⬎0.05). The mean SBP from spinal block until delivery was similar over time for all the three groups. The incidence of reactive hypertension was more in Group M (10 patients⬍ 0.05) then in group E (6 patients) and group P (3 patients). Total drug consumption to meet target blood pressure till delivery was 39.3 ⫾ 14.6 mg in group E, 1.7⫾0.9 mg in group M and 283.6⫾99.8 g in group P. The incidence of nausea and vomiting was comparable in the three groups. Conclusion: All the three vasopressors were equally effective in maintaining maternal blood pressure as well as umbilical pH during spinal anaesthesia for LSCS. None of the vasopressors had any detrimental effects on fetal and maternal outcome.
465. Ultrasound guided transversus abdominis plane [TAP] block for caesarean sections S. Sivasubramaniam, E.J. Francis Jayadoss, K. Sadan Burton Hospital, Burton upon Trent, UK Background: Ultrasound guided regional blocks have contributed to multimodal analgesia in facilitating early ambulation with minimal side effects. Encouraged by the use of TAP blocks for analgesia for laparotomy we sought to evaluate the duration of analgesia provided by the block in patients undergoing caesarean sections. Aim: We aimed to look at post-operative analgesic requirements, pain scores, time to request first dose of analgesia and duration of analgesia provided by TAP blocks in parturient undergoing caesarean sections under central neuraxial blockade. We also aimed to look at learning curves for performance of TAP blocks. Methods: TAP blocks were performed in 25 patients at the end of LSCS. The transversus abdominis plane was identified using high frequency ultrasound with an in plane technique. The block was performed with 20 ml of 0.25-0.375 levobupivacaine on each side. The time taken to perform the blocks were noted in each case. We recorded pain scores at 6hrs, 12 hrs and 24hrs postoperatively and the time after the surgery they requested their first analgesia. Results: The mean duration for performing block was 4.16 minutes. Mean Visual analogue score at 6 hours was 1, at 12 hours was1.6 and at 24 hours was 2.72 out of 10. The mean time for request of first analgesic dose was 9.3hrs. The mean total analgesic requirement was 4mg of IM morphine and 3.5mg of oralmorphine. No patients had nausea. 66 % of patients were very satisfied and 44% of patients were satisfied with painrelief management. Conclusion: Ultrasound guided TAP block is an excellent regional anaesthetic technique providing up to 24 hours of post-operative analgesia after caesarean section thereby reducing morphine requirements. We did not encounter any complications or side effects of the procedure during the study. The technique is easy to learn with a minimal learning curve.
Posters
•
Obstetrics
415. Fetal and maternal outcome after control of maternal blood pressure during cesarean section under spinal anaesthesia: comparison of three vasopressors K. Jain, N. Bharadwaj PGIMER, Anaesthesia and Intensive Care, Chandigarh, India Background and Aims: Maintaining systolic blood pressure at 100% of baseline is best for fetal and maternal outcome. We hypothesized that irrespective of the vasopressors used, maintaining SBP at 100% of baseline with phenylephrine (P), Metraminol (M) or ephedrine (E) will produce the best fetal ph after cesarean section under subarachnoid block. Methods: Ninety ASA1 women scheduled for elective LSCS were randomly allocated to receive P, M or E. SAB block was established with patient in left lateral position using 2.5 cc of 0.5% hyper baric bupivacaine. Immediately following SAB, patients received a bolus of the study drug (E⫽2.5mg, M⫽0.25 mg, P⫽30 g) followed by infusions (E⫽ 5 mg/min, P⫽60 g/min, M⫽0.5 mg/min) to maintain SBP at 100 % baseline till delivery of the baby. Umbilical blood gases, maternal Haemodynamic parameters and complications were recorded. Results: The umbilical pH was comparable in all three groups (p⬎0.05). The mean SBP from spinal block until delivery was similar over time for all the three groups. The incidence of reactive hypertension was more in Group M (10 patients⬍ 0.05) then in group E (6 patients) and group P (3 patients). Total drug consumption to meet target blood pressure till delivery was 39.3 ⫾ 14.6 mg in group E, 1.7⫾0.9 mg in group M and 283.6⫾99.8 g in group P. The incidence of nausea and vomiting was comparable in the three groups. Conclusion: All the three vasopressors were equally effective in maintaining maternal blood pressure as well as umbilical pH during spinal anaesthesia for LSCS. None of the vasopressors had any detrimental effects on fetal and maternal outcome.
465. Ultrasound guided transversus abdominis plane [TAP] block for caesarean sections S. Sivasubramaniam, E.J. Francis Jayadoss, K. Sadan Burton Hospital, Burton upon Trent, UK Background: Ultrasound guided regional blocks have contributed to multimodal analgesia in facilitating early ambulation with minimal side effects. Encouraged by the use of TAP blocks for analgesia for laparotomy we sought to evaluate the duration of analgesia provided by the block in patients undergoing caesarean sections. Aim: We aimed to look at post-operative analgesic requirements, pain scores, time to request first dose of analgesia and duration of analgesia provided by TAP blocks in parturient undergoing caesarean sections under central neuraxial blockade. We also aimed to look at learning curves for performance of TAP blocks. Methods: TAP blocks were performed in 25 patients at the end of LSCS. The transversus abdominis plane was identified using high frequency ultrasound with an in plane technique. The block was performed with 20 ml of 0.25-0.375 levobupivacaine on each side. The time taken to perform the blocks were noted in each case. We recorded pain scores at 6hrs, 12 hrs and 24hrs postoperatively and the time after the surgery they requested their first analgesia. Results: The mean duration for performing block was 4.16 minutes. Mean Visual analogue score at 6 hours was 1, at 12 hours was1.6 and at 24 hours was 2.72 out of 10. The mean time for request of first analgesic dose was 9.3hrs. The mean total analgesic requirement was 4mg of IM morphine and 3.5mg of oralmorphine. No patients had nausea. 66 % of patients were very satisfied and 44% of patients were satisfied with painrelief management. Conclusion: Ultrasound guided TAP block is an excellent regional anaesthetic technique providing up to 24 hours of post-operative analgesia after caesarean section thereby reducing morphine requirements. We did not encounter any complications or side effects of the procedure during the study. The technique is easy to learn with a minimal learning curve.