The analgesic effectiveness of an Ilioinguinal-Transversus Abdominis Plane (iTAP) injection technique nerve block in addition to opioid plus NSAID analgesia for elective Caesarean Sections.

PURPOSE One of the methods of providing pain relief after a Caesarean Section involves the injection of local anaesthetic into the muscle layers to surround the nerves that supply pain sensation to the lower abdomen. These blocks are called Ilioinguinal / Iliohypogastric nerve blocks and Transversus Abdominis Plane (TAP) blocks and have been used for a range of surgeries. This helps to reduce pain over the surgical wound where the Caesarean Section is performed. The purpose of this study is to determine if combining these blocks in addition to opioid and anti-inflammatory pain management will improve pain relief in the first 24 hours for women who have an elective Caesarean Section. This block will be performed at the end of the Caesarean section before the spinal anaesthetic has worn off. HYPOTHESIS Our primary aim is to determine whether administering the modified Ilioinguinal-Transversus Abdominis Plane (iTAP) nerve block in addition to opioid plus NSAID analgesia is superior to opioid plus NSAID analgesia alone following caesarean section with a Pfannenstiel incision. STUDY DESIGN AND INTERVENTION Approximately 100 volunteers will participate in this study and the study will be conducted at the Lyell McEwin Hospital. You will be enrolled in this study on the day of your Caesarean Section and randomly allocated to one of two groups. One group will receive pain medication with the iTAP block in the Post Anaesthetic Recovery Unit (PARU) as well as opioid medication (Fentanyl) through a Patient Controlled Analgesia (PCA) device. The second group will receive pain medication with the PCA but will receive a placebo block. A placebo is a medication with no active ingredients or a procedure without any medical benefit. It will feel like the real thing but it is not. Your participation in the study will continue until 24 hours after the iTAP block / placebo block. OUTCOMES We will be measuring total pain medication usage (opioids) and pain levels (VAS) over a 24 hour period. We will also measure adverse side effects of pain medication and the block, as well as the satisfaction of our participants. Hopefully there will be less pain and pain medication usage in our interventional group.