Ultrasound-guided TAP Block Vs Local Wound Infiltration for Analgesia After Cesarean Section.

Adequate pain control after cesarean delivery is a major concern for both parturients and obstetrician, and it usually comprise a combination of systemic and regional techniques. The transversus abdominis plane (TAP) block, affecting the nerves supplying the anterior abdominal wall, is a recently introduced, promising regional analgesic technique for a variety of abdominal and pelvic surgeries including cesarean delivery . Infiltration of local anesthetic into the surgical wound (either as a single shot or using indwelling catheters) has long been used for postoperative analgesia, Both the TAP block and wound infiltration, are superior to placebo, however, it is unknown which of them provides better analgesia after cesarean delivery because of a scarcity of randomized clinical trials. This study aimed to compare bilateral US guidedTAP block with single-shot local anesthetic wound infiltration for analgesia after cesarean delivery performed under general anesthesia. The investigators hypothesized that the TAP block would decrease postoperative cumulative opioid consumption at 24 hours.

Inclusion Criteria: * • Patients undergoing elective cesarean section under general anathesia * Pfannenstiel Skin Incision * Age between 18 and 40 years old * BMI between 18 and 35 kg/m2 Exclusion Criteria: * • Patient refusal. * BMI\35 (require different dose of analgesia) * Height \ 180 cm (require different dose of analgesia) * Patients with any neurological deficit due to neuropathy and pain score affection * Patients with bleeding disorders which may lead to hematoma * HTN (Vasculopathy which can lead to hematoma). * Cardiac disease ( Vasculopathy on anticoagulant which can lead to hematoma) * DM (decrease systemic and local immunity which can lead to abscess at injection site and due to neuropathy and pain score affection). * Liver disease (defective clotting factors). * A history of relevant drug allergy or Hypersensitivity to any of the drugs used in the study due to impair of proper follow up of pain postoperative * History of recent opioid exposure due to affection on pain score * Local skin infection due to abscess formation * Obstetric complications e.g placenta previa and rupture uterus due to extensive tissue damage and dissection