|LETTER TO THE EDITOR
|Year : 2011 | Volume
| Issue : 2 | Page : 97-98
Transversus abdominis analgesia plane block versus transcutaneous electrical nerve stimulation for post caesarian pain relief
Department of Anaesthesia, Royal Hospital, Muscat, Sultanate of Oman
|Date of Web Publication||17-Mar-2012|
Department of Anaesthesia, Royal Hospital, Muscat
Sultanate of Oman
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Prasanna A. Transversus abdominis analgesia plane block versus transcutaneous electrical nerve stimulation for post caesarian pain relief. J Obstet Anaesth Crit Care 2011;1:97-8
|How to cite this URL:|
Prasanna A. Transversus abdominis analgesia plane block versus transcutaneous electrical nerve stimulation for post caesarian pain relief. J Obstet Anaesth Crit Care [serial online] 2011 [cited 2018 Nov 15];1:97-8. Available from: http://www.joacc.com/text.asp?2011/1/2/97/93998
I would like to make the following comments regarding the article on comparison of transversus abdominis analgesia plane (TAP) block with transcutaneous electrical nerve stimulation for postoperative pain relief following cesarean section. 
- TAP block described in the article has been done as a blind technique. The description that double click techniqueas described by Rafi  confirmed that the needle was in the transverse abdominis muscle is an assumption. The double click technique is also used for hernia block to deposit the drug in the internal oblique as to pierce the fascia of the external and internal oblique to block the ilioinguinal nerve even when using the nerve locator or the ultrasound to deposit the drug. Hence, this may not be a fool proof method to be certain of the deposition. The pain relief that the authors claim could have been due to the bilateral superficial ilioinguinal nerve block than what the authors' theoretical claim. There is a distinct possibility that the same VAS scores may have been obtained by direct bilateral blocking of the ilioinguinal and iliohypogastric nerves (hernia block) or wound infiltration?
- There is no mention of the route of administration of parenteral diclofenac. The body weight in both groups ranged from 42 to 62 kg. Did they actually administer by per kg body weight since the formulation dispensed is 75 mg in 2 ml or 3 ml depending on the manufacturer. If so, how did they measure the exact dose and dispense? Did they also adhere to the maximum dose in a day by parenteral route? What was the maximum dose that they used since it was administered at every 8 h.
- There is no mention of the VAS score at rest and on movement measured from 30 min onward. The authors mention that none in both groups required rescue analgesia. Did they allow patients to ambulate after subarachnoid block? How long after the subarachnoid block did they advocate ambulation? What movements did the authors advocate to record VAS on movement at 30 min and onward?
- It is unlikely that the analgesic effect of single shot TAP block can last for 24 - 48 h. In the present study, the author's experience regarding the same would be of great importance.
- The authors should have mentioned the permissible limit of the local anesthetics used in this block and the equivalent dose and concentration for 1% lignocaine with bupivacaine. Does absence of clinical evidence of side effects give the authority to opine that the dose of drug used had not crossed the toxic blood levels? Was it just a coincidence?
An excellent review on TAP block following out patient laparoscopy  should have been referred in the article.
| References|| |
|1.||Kerai S, Saxena KN, Anand R, Dali JS, Taneja B. Comparative evaluation of transverses abdominis analgesia plane block with transcutaneous electrical nerve stimulation for postoperative following Lower segment caesarean section. J Obstet Anaesth Crit Care 2011;1:30-4. |
|2.||Rafi AN. Abdominal field block: A new approach via the lumbar triangle. Anaesthesia 2001;56:1024-6. |
|3.||De Oliveira GS Jr, Fitzgerald PC, Marcus RJ, Ahmad S, McCarthy RJ. A dose-ranging study of the effect of transversus abdominis block on postoperative quality of recovery and analgesia after outpatient laparoscopy. Anesth Analg 2011;113:1218-25. |