Comparative Study Between Bilateral Ultrasound-Guided Transversus Abdominis Plane Block and Parenteral Diclofenac for Postoperative Analgesia Following Lower Segment Caesarean Section: A Randomized Comparative Study

Background: Pain after a caesarean section does more than hurt. It keeps mothers from moving, from caring for a newborn, from settling into those first fragile hours of bonding. Bilateral ultrasound-guided transversus abdominis plane (TAP) block has emerged as a genuine alternative, or a useful add-on, to the parenteral analgesics most units still reach for by default. We set out to compare bilateral TAP block against parenteral Diclofenac head-to-head, each used alone as the sole mode of postoperative analgesia, following lower segment caesarean section (LSCS) under spinal anaesthesia. Material and Methods: In this prospective, randomized comparative study, we randomized 60 women undergoing elective LSCS under spinal anaesthesia into two equal groups. Group T (n = 30) received bilateral ultrasound-guided TAP block with 20 mL of 0.25% Bupivacaine on each side after wound closure; Group D (n = 30) received intravenous Diclofenac 75 mg as a stat dose, then every 8 hours for 24 hours. We tracked Visual Analogue Scale (VAS) score, duration of analgesia, requirement of rescue analgesia and quality of pain relief for 24 hours. Intravenous Paracetamol 1 g served as first-line rescue; Tramadol 50 mg backed it up as second-line. We analysed the data in SPSS v23.0, taking p < 0.05 as significant. Results: TAP block bought patients more time: a mean of 6.3 hours of analgesia versus 3.9 hours with Diclofenac. In Group D, 26 of 30 patients needed their first rescue dose within 4 hours, against just 4 of 30 in Group T; most of the TAP block patients — 24 of them — held out until 5–8 hours post-op. Over 24 hours, Group T needed fewer rescue doses overall, 69 versus 86. Pain relief quality came out excellent-to-moderate in 86.7% of Group T patients versus 70% of Group D patients (p < 0.001). Neither group saw a single local or systemic complication. Conclusion: Bilateral ultrasound-guided TAP block with 0.25% Bupivacaine outperforms parenteral Diclofenac on every measure that matters here: longer analgesia, fewer rescue doses, and better overall pain relief, all without any added safety concern.

Keywords: Caesarean section; Transversus abdominis plane block; Bupivacaine; Diclofenac; Postoperative analgesia; Regional anaesthesia.