Post caesarean delivery pain control with bilateral ultrasound-guided transversus abdominis plane block using 18G intravenous cannula: a case report.

Summary

In recent time ultrasound guided transversus abdominis plane block has become popular in the developing countries as option in post-operative pain management. Its use in multimodal setting spares the use of opioids and the associated side effects like sedation however; availability of materials could most time limits its routine use. We present a case of transversus abdominis plane block that was performed on a 36 year old female with America Society of Anaesthesiologist physical status classification II. She was a gravida 3 para 2 female with 2 previous Caesarean section. Transversus abdominis plane block (TAP) was administered with 18G intravenous cannula needle because our stock of regional anaesthetic needle was exhausted at the time we intended conducting the block. Her weight and height, were 63kg, 1.57 meters. Transversus abdominis plane block in a multimodal setting was planned for the patient at preoperative anaesthetic review. This was because the patient specifically did not want any form of sedation in the post-operative period. The Cesarean section was done under subarachnoid block. Immediately after the surgery, it was observed that our stock of regional anaesthetic needle was exhausted. Consultation with the patient was made and consent was obtained to use available alternative. A Size 18G intravenous cannula needle was considered as alternative. It was therefore use in place of regional anaesthesic needle to access the transversus abdominis plane under ultrasound guide. After confirming the correct needle placement, bilateral in plane transversus abdominis plane block was conducted using a total of 40mL of 0.25% plain bupivacaine. The numerical pain score was consistently low in the post-operative period. On a four-point satisfaction scale, patient rated her satisfaction with post operative pain control as 4. There was no incidence of complication from the performance of transversus abdominis plane block. This observation shows that ultrasound guided transversus abdominis plane block can be done with regular intravenous cannula needle with minimal injury in the absence of regional anaesthesia needle.

Keywords: Post Caesarean pain management, transversus abdominis plane block (TAP), regional anaesthesia needle.