Transverse abdominal plane block with low-dose sufentanil vs high-dose sufentanil for postcesarean pain: a...

Management of postoperative pain is the main requirement of anesthesia for cesarean section. Generally, opioids (especially morphine) with transverse abdominal muscle plane block anesthesia are used as an effective analgesic method for postcesarean section pain but opioids have adverse effects of sedation, vomiting, and/or respiratory depressions of women.

To compare 2 postoperative analgesia methods (transverse abdominal plane block followed by patient-controlled intravenous analgesia (PCIA) containing a low dose of sufentanil versus PCIA containing a high dose of sufentanil) on the postoperative maternal and neonatal course after cesarean-section.

Parturients age 20 to 40 years, height 152 to 175 cm, weight 60 to 80 kg, body mass index less than 30 kg/m², American Society of Anesthesiologists (ASA) II grade, singleton term pregnancy, and 37 to 42 weeks of pregnancy were included in double-blind, randomized (the random number chart method) trial. Parturient underwent bilateral transverse abdominal muscle plane block anesthesia with multimodal analgesia pump containing 50 mcg/100 mL of sufentanil (Group E, n=99) or 100 mcg/100 mL of sufentanil (Group C, n=98) after cesarean section.

Consumption of sufentanil within 48 hours in the group E was less than the group C (P<.001). The first time of postcesarean analgesic pump was later in the group E (P<.001). The number of analgesic pump compression in the group E was less than that in the group C (P<.001). The first exhaust time and first getting out of bed time in the group E were earlier than those in the group C (P<.001 for both). Postcesarean adverse reactions such as skin itching (P<.001), nausea and vomiting (P=.037), and 3 months of chronic pain (P=.011) reported fewer in the group E than those of women of the group C. The changes of the VAS value of the resting state and the movement conditions at 6 h and 12 h were higher in the group C as compared to those of group E (P<.05 for all). The serum prolactin (PRL) after cesarean section was higher in the group E compared to those of the group C (P<.05) and the first time of getting out of bed (P<.05) and colostrum's time after cesarean section were earlier in the group E.

Transverse abdominal muscle plane block combine with sparing opioid regimen in multimode analgesia after cesarean section, provides effective management of postcesarean pain management, improve the impact of postcesarean pain on PRL secretion with, promoted maternal recovery, and with less adverse effects.

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