A comparison of spinal anaesthesia with and without transversus abdominis plane block in patients undergoing elective caesarean section at Windhoek Hospital Complex
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Date
2025
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Publisher
University of Namibia
Abstract
Background: Pain is a known outcome complication of surgery in the post-operative
period, especially after Caesarean section. Lack of pain relief postoperatively also poses
great risks for patients’ health. The combination of Transversus Abdominis Plane
(TAP) block with spinal anaesthesia is emerging as a superior approach for managing
postoperative pain, particularly in abdominal surgeries. While spinal anaesthesia
provides effective lower body analgesia, it can result in inadequate pain control and
side effects like hypotension. TAP block enhances pain relief without the adverse
effects associated with spinal anaesthesia. Overall, the integration of TAP block with
spinal anaesthesia offers significant advantages in pain management strategies.
Aim: The main objective of this study was to compare the benefit of adding transversus
abdominis plane (TAP) block to spinal anaesthesia versus spinal anaesthesia alone in
patients undergoing elective Caesarean section.
Setting and Design: This was a randomised single-blinded control study conducted
over a period of six months in the maternity theatres of Windhoek Central Hospital and
Intermediate Hospital, Katutura.
Methods and Materials: The effect size on pain scores was determined to be the
magnitude of the difference between groups, according to a study by Cohen et al. A
medium effect size of 0.5, an alpha error of 0.05, and a power of 80% were used to
calculate the number of patients required in each group. The result was 64 patients per
group. Assuming an average attrition rate of 11% quoted in a similar study, this
suggested that 72 patients were required per group so that in total, the study sample size
constituted 144 patients. Patients planned for elective caesarean section were randomly
allocated to two groups, A and B. Group A received spinal anaesthesia only with 0.5%
heavy bupivacaine 9 mg (1.8 ml) and fentanyl 15 mcg. Group B received spinal
anaesthesia and TAP block using 40 ml plain bupivacaine 0.25%. (with the same drug
doses as in Group A). The analgesic efficacy spinal anaesthesia alone and spinal
anaesthesia combined with TAP block was compared over various time intervals (2, 4,
6, 12, and 24 hours postoperatively) both at rest and movement.
Statistical Analysis: Numbers with percentages were used to represent nominal
variables, while continuous variables were summarized in terms of mean ± SD or
median and interquartile range, as appropriate. A statistician examined the distribution
of the data before
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using the Student's T-test to compare the results from the study groups. When
appropriate, the Z score for a two-population proportion was applied. Statistical
significance was defined as a P-value of less than 0.05.
Results: At both rest and movement, spinal anaesthesia alone consistently showed
higher pain scores compared to TAP block across all time intervals. Statistically
significant differences were observed with p value of (p= <0.001), except for the 2-hour
mark at rest where no significant difference of between the two groups was observed
(p=0.97).
Conclusion: This study highlights the effectiveness of TAP block as an adjunct to
spinal anaesthesia in managing postoperative pain following Caesarean section.
Patients who received both spinal anaesthesia and TAP block reported higher levels of
satisfaction with their pain relief, compared to those who received spinal anaesthesia
alone. These findings underscore the potential benefit of incorporating TAP block into
multimodal analgesic approaches to enhance postoperative pain management and
patient satisfaction
Description
A thesis in partial fulfilment for the requirements for the Degree of Master of Medicine (Anesthesiology, Critical care and Pain management)
Keywords
Spinal Anaesthesia, Transversus abdominis plane block (TAP), Caesarean section, Heavy bupivacaine, Fentanyl, Pethidine, Namibia, University of Namibia