Abstract

Background: Multimodal analgesia is a combination of analgesic methods that act on different sites of the pain pathway. The objective of this study was to evaluate the efficacy of multimodal analgesia after cesarean delivery (CD) and to investigate the adverse effects of these methods. Materials and method: A total of 180 women received spinal anesthesia for CD were divided into three groups. Group Para-TAP received paracetamol and transverse abdominis plane block (TAP block); group Para-Diclo received paracetamol and diclofenac; group Para-Diclo-TAP received paracetamol, diclofenac and TAP block. Paracetamol was given intravenously (IV) 1 g, orally 1 g every 8 h for 24 h, diclofenac was inserted rectally 1 h after surgery, TAP block were performed when uterine palpation caused a VAS score of 2 points. Pain score was measured with the visual analogue scale (VAS) at rest and on movement at 0, 2, 4, 6, 8, 12, 18 and 24 h for the first 24 h. Patient comfort and satisfaction with analgesia was evaluated at the end of 24 h. The primary outcome was VAS score and the rate of analgesic request. The secondary measures of outcome were satisfaction with the pain management and side effects. Breakthrough pain was treated with 5 mg IV morphine when the VAS at rest ≥ 4 or on movement ≥ 5. Results: The VAS score ≤ 3 at rest of the 3 groups was 76.67%, 90% and 93.33%, respectively, the VAS score on movement ≤ 3 of the 3 groups was 38.33%, 61.67% and 76.67%, respectively. The rate of analgesic request of 3 groups was 23.33%, 10% and 6.7%, respectively, group Para-Diclo-TAP did not have the second analgesic request. All 3 groups had a low rate of itch and nausea, the difference between side effects was not significant. The Para-TAP group was more effective than the Para-Diclo group during the first 6h, the Para-Diclo group was more effective during 12-24 h period, the Para-Diclo-TAP group was more effective than the Para-Diclo group for a period of 18h. Conclusion: All 3 methods are effective in pain relief after CD, in which the combination of paracetamol, diclofenac, and TAP block brings outstanding efficiency but side effects are equivalent to other methods.