Effect of a Transversus Abdominis Plane Block on Wound Healing, Stress, and Immune Response After a Cesarean Delivery

Summary

The primary purpose of this study is to determine whether the addition of a TAP block to standard analgesia after the cesarean delivery will impact postoperative wound healing and attenuate postoperative stress and immune response. Random allocation of participants in 3 groups: group SA (standard analgesia), group L (TAP block with levobupivacaine), and group D (TAP block with levobupivacaine + dexmedetomidine). All participants will undergo elective cesarean section through Pfannestiel incision under spinal anesthesia. They will receive standard postoperative pain management with acetaminophen, nonsteroidal anti-inflammatory drugs, and tramadol. Groups L and D will additionally receive bilateral ultrasound-guided TAP block with 20 ml 0,25% levobupivacaine or with 20 ml 0,25% levobupivacaine with the addition of 0,5 μg/kg dexmedetomidine. TAP block will be performed in the theatre immediately after the cesarean delivery. Venous blood samples will be collected before the surgery and on the third postoperative day. Complete blood count and serum cortisol levels will be measured. REEDA scale will be used for assessing wound healing.

Timeline

Start

2024-09-03

Primary completion

2025-03-17

Completion

2025-03-20

Publications

• Background Lavand'homme P. Postoperative cesarean pain: real but is it preventable? Curr Opin Anaesthesiol. 2018 Jun;31(3):262-267. doi: 10.1097/ACO.0000000000000585.
• Background Ernawati E, Amirah A, Sumartono C, Aditiawarman A. Comparison of Post-Caesarean Section Wound Healing Methods Based on Reeda Scale and Platelet Lymphocyte Ratio. Syst Rev Pharm. 2020;11(7):5. doi:10.31838/srp.2020.7.49
• Background Rotem R, Erenberg M, Rottenstreich M, Segal D, Yohay Z, Idan I, Yohay D, Weintraub AY. Early prediction of post cesarean section infection using simple hematological biomarkers: A case control study. Eur J Obstet Gynecol Reprod Biol. 2020 Feb;245:84-88. doi: 10.1016/j.ejogrb.2019.12.009. Epub 2019 Dec 23.
• Background Hughes O, MacQuhae F, Rakosi A, Herskovitz I, Kirsner RS. Stress and wound healing. U: França K, Jafferany M, ur. Stress and skin disorders: Basic and clinical aspects. Cham: Springer; 2017. P. 185-207.
• Background Childs C, Sandy-Hodgetts K, Broad C, Cooper R, Manresa M, Verdu-Soriano J. Risk, Prevention and Management of Complications After Vaginal and Caesarean Section Birth. J Wound Care. 2020 Nov 1;29(Sup11a):S1-S48. doi: 10.12968/jowc.2020.29.Sup11a.S1. No abstract available.
• Background Siddiqui MR, Sajid MS, Uncles DR, Cheek L, Baig MK. A meta-analysis on the clinical effectiveness of transversus abdominis plane block. J Clin Anesth. 2011 Feb;23(1):7-14. doi: 10.1016/j.jclinane.2010.05.008.
• Background Liu R, Qin H, Wang M, Li K, Zhao G. Transversus abdominis plane block with general anesthesia blunts the perioperative stress response in patients undergoing radical gastrectomy. BMC Anesthesiol. 2019 Nov 7;19(1):205. doi: 10.1186/s12871-019-0861-0.
• Background Varshney A, Prabhu M, Periyadka B, Nanjundegowda DC, Rao A. Transversus abdominis plane (TAP) block with levobupivacaine versus levobupivacaine with dexmedetomidine for postoperative analgesia following cesarean delivery. J Anaesthesiol Clin Pharmacol. 2019 Apr-Jun;35(2):161-164. doi: 10.4103/joacp.JOACP_372_17.
• Background Sun Q, Liu S, Wu H, Ma H, Liu W, Fang M, Liu K, Pan Z. Dexmedetomidine as an Adjuvant to Local Anesthetics in Transversus Abdominis Plane Block: A Systematic Review and Meta-analysis. Clin J Pain. 2019 Apr;35(4):375-384. doi: 10.1097/AJP.0000000000000671.
• Background Surhonne N, Hebri C, Kannan S, Duggappa DR, Rs RR, Mapari CG. The effect of anesthetic techniques on neutrophil to lymphocyte ratio in patients undergoing infraumbilical surgeries. Korean J Anesthesiol. 2019 Oct;72(5):458-465. doi: 10.4097/kja.d.19.00022. Epub 2019 May 17.
• Background Kiriakopoulos N, Grigoriadis S, Maziotis E, Philippou A, Rapani A, Giannelou P, Tsioulou P, Sfakianoudis K, Kontogeorgi A, Bakas P, Mastorakos G, Koutsilieris M, Simopoulou M. Investigating Stress Response during Vaginal Delivery and Elective Cesarean Section through Assessment of Levels of Cortisol, Interleukin 6 (IL-6), Growth Hormone (GH) and Insulin-Like Growth Factor 1 (IGF-1). J Clin Med. 2019 Jul 27;8(8):1112. doi: 10.3390/jcm8081112.
• Background McDonnell JG, Curley G, Carney J, Benton A, Costello J, Maharaj CH, Laffey JG. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg. 2008 Jan;106(1):186-91, table of contents. doi: 10.1213/01.ane.0000290294.64090.f3.
• Background Sultan P, Kamath N, Carvalho B, Bansal P, Elkhateb R, Dougan S, Whittington J, Guo N, El-Sayed Y, Mhyre J, Sharawi N. Evaluation of inpatient postpartum recovery using the Obstetric Quality of Recovery-10 patient-reported outcome measure: a single-center observational study. Am J Obstet Gynecol MFM. 2020 Nov;2(4):100202. doi: 10.1016/j.ajogmf.2020.100202. Epub 2020 Aug 17.

Drugs

Indications

No indication recorded.