Efektivitas Blok Saraf Tepi Transversus Abdominis Plane (TAP) terhadap Nyeri Pascaoperasi Seksio Sesarea Darurat dalam Kondisi Bencana: Penelitian Kohort Retrospektif
Abstract
Latar Belakang: Tsunami Palu 2018 menyebabkan peningkatan tajam tindakan seksio sesarea darurat di RSUD Undatta. Dalam kondisi keterbatasan, pendekatan analgesia regional seperti blok saraf tepi Transversus Abdominis Plane (TAP) block dapat menjadi strategi efektif untuk menekan kebutuhan opioid dan mempercepat pemulihan pasien.
Tujuan: Menilai efektivitas Blok saraf tepi TAP dalam mengurangi nyeri pascaoperasi dan konsumsi opioid pada pasien seksio sesarea darurat dalam situasi bencana.
Metode: Penelitian kohort retrospektif terhadap 100 pasien yang menjalani seksio sesarea darurat selama Oktober–November 2018. Dibandingkan dua kelompok: Blok saraf tepi TAP (n=50) vs analgesia sistemik konvensional (n=50). Parameter evaluasi: skor Visual Analog Scale (VAS) pada 1, 6, 12, 24 jam; konsumsi morfin ekuivalen; dan komplikasi.
Hasil: Skor nyeri VAS kelompok TAP signifikan lebih rendah di semua titik waktu (p<0.01), dengan rata-rata skor VAS 24 jam: 2.0 ± 0.9 (vs 4.7 ± 1.3). Penggunaan morfin juga berkurang secara signifikan (1.5 mg vs 4.3 mg; p<0.01). Tidak ada komplikasi berat; 4% pasien TAP mengalami parestesia ringan.
Simpulan: Blok TAP efektif dan aman sebagai analgesia pascaoperasi untuk seksio sesarea darurat dalam kondisi bencana. Teknik ini layak diintegrasikan ke dalam protokol anestesi kebencanaan
Downloads
References
Yan ZR, Chen LJ, Zhang SJ, Zhang LX, Lu H, et al. The transversus abdominis plane block in conjunction with intrathecal morphine use after cesarean section in women with severe pre-eclampsia: a randomized controlled trial. BMC Anesthesiol. 2023;23:100. doi:10.1186/s12871-023-02061-9. Doi: https://doi.org/10.1186/s12871-023-02061-9
Salman MS, Shaker A, Elbassyouny HR, Elnaggar RM, Raslan M, Khayal AE, et al. The efficacy of transversus abdominis plane block for analgesia in comparison with local anesthetic wound infiltration post-cesarean section: a randomized comparative double-blinded clinical trial. Clin Exp Obstet Gynecol. 2024;51(5):1-7. doi:10.31083/j.ceog5105120. Doi: https://doi.org/10.31083/j.ceog5105120
McDonnell JG, Curley G, Carney J, Benton A, Costello J, Maharaj CH, et al. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg. 2008;106(1):186–91. Doi:10.1213/01.ane.0000298632.08274.dd https://pubmed.ncbi.nlm.nih.gov/18165577/
Abdallah FW, Halpern SH, Margarido CB. TAP block for postoperative analgesia after Caesarean delivery under spinal anesthesia: a systematic review and meta-analysis. Br J Anaesth. 2012;109(5):679–87. doi:10.1093/bja/aes279 https://pubmed.ncbi.nlm.nih.gov/22907337/
Eslamian L, Jalili Z, Jamal A, Marsoosi V, Movafegh A. TAP block reduces postoperative pain and analgesic consumption in elective cesarean under general anesthesia. J Anesth. 2012;26(3):334–338. doi:10.1007/s00540-012-1336-3 https://pubmed.ncbi.nlm.nih.gov/22354671/
Petersen PL, Mathiesen O, Troup H, Dahl JB. TAP block: a valuable option of postoperative analgesia? Acta Anaesthesiol Scand. 2010;54(5):529–35. doi:10.1111/j.1399-6576.2010.02215. https://pubmed.ncbi.nlm.nih.gov/20175754/
De Oliveira GS Jr, Castro-Alves LJ, Nader A, Kendall MC, McCarthy RJ. TAP block to ameliorate postoperative pain after laparoscopic surgery: a meta-analysis. Anesth Analg. 2014;118(2):454–63. Doi:10.1213/ANE.0000000000000066 https://pubmed.ncbi.nlm.nih.gov/24445643/
Peng K, Ji FH, Liu HY, Wu SR. Ultrasound-guided transversus abdominis plane block for analgesia in laparoscopic cholecystectomy: a systematic review and meta analysis. Med Princ Prac. 2016;25(3):237–46. Doi: 10.1159/000444688. https://pubmed.ncbi.nlm.nih.gov/26885872/
Kanazi GE, Aouad MT, Abdallah FW, Khatib MI, F Adham AMB, Harfoush DW, et al. Analgesic efficacy of subarachnoid morphine vs TAP block post-cesarean: a randomized trial. Anesth Analg. 2010;111(2):475–81. doi:10.1213/ANE.0b013e3181e30b9f https://pubmed.ncbi.nlm.nih.gov/20488929/
Nag DS, Gehlot P, Sharma P, Kumar H, Singh UK, et al. Ropivacaine with dexmedetomidine in TAP block for cesarean: a randomized trial. Cureus. 2024;16(7):e65588. doi:10.7759/cureus.65588https://pubmed.ncbi.nlm.nih.gov/39192898/
Sachdeva J, Sinha A. Dexamethasone in TAP block prolongs analgesia in cesarean: a trial. Indian J Pain. 2016;30(3):181–85. doi:10.4103/0970-5333.198056 https://journals.lww.com/ijpn/fulltext/2016/30030/randomized_controlled_trial_to_study_the_effect_of.9.aspx/
Boules ML, Goda AS, Abdelhady MA, El-Nour Abd El-Azeem SAA, Hamed MA. ESP block vs TAP block for cesarean analgesia: a controlled study. J Pain Res. 2020;13:1073–080. Doi:10.2147/JPR.S253343https://pubmed.ncbi.nlm.nih.gov/32547172/
Mishriky BM, George RB, Habib AS. TAP block for cesarean delivery: systematic review and meta-analysis. Can J Anaesth. 2012;59(8):766–78. Doi:10.1007/s12630-012-9729-1 https://pubmed.ncbi.nlm.nih.gov/22622954/
Sanderson BJ, Doane MA. TAP catheters for abdominal surgery analgesia: evidence review. Reg Anesth Pain Med. 2018;43(1):5-13. Doi:10.1097/AAP.0000000000000681 https://pubmed.ncbi.nlm.nih.gov/29099414/
Kristin AB, Gregg N, Natalie G, Joshua F, Sophia P, Michael C, Sunita G, Steven PB. Effect of transversus abdominis plane block on postoperative outcomes in gynecologic oncology patients managed on an Enhanced Recovery After Surgery. J Gynec Onc. 2023;178:1-7 https://doi.org/10.1016/j.ygyno.2023.09.003https://www.sciencedirect.com/science/article/pii/S0090825823014671
Kamel AAF, Amin OAI, Ibrahem MAM. Bilateral ultrasound-guided erector spinae plane block versus transversus abdominis plane block on postoperative analgesia after total abdominal hysterectomy. Pain Physician. 2020;23(4):375–82. Available from: https://pubmed.ncbi.nlm.nih.gov/32709172
Erol MK, Şengel A, Tammo Ö, Seçilmiş S, Kaya F. The effect of TAP block use on postoperative analgesia in cesarean section. Eur Rev Med Pharmacol Sci. 2023;27(7):2786–93. doi:10.26355/eurrev_202304_31909. https://pubmed.ncbi.nlm.nih.gov/37070878/
Urfali S, Hakimoğlu S, Turhanoğlu S, Koyuncu O. Transversus abdominis plane block following cesarean section: a prospective randomized controlled study comparing the effects on pain levels of bupivacaine, bupivacaine + dexmedetomidine, and bupivacaine + dexamethasone. J Clin Med. 2024;13(14):4270. doi:10.3390/jcm13144270. https://pmc.ncbi.nlm.nih.gov/articles/PMC11278202/
Jadon A, Jain P, Chakraborty S, Motaka M, Parida SS, Sinha N, et al. Role of ultrasound guided transversus abdominis plane block as a component of multimodal analgesic regimen for lower segment caesarean section: a randomized double blind clinical study. BMC Anesthesiol. 2018;18:53. doi:10.1186/s12871-018-0523-7. Doi: 10.1186/s12871-018-0512-x. https://pubmed.ncbi.nlm.nih.gov/29759061/
Zeng, J., Hong, A., Gu, Z, Jian J, Liang X. Efficacy of transversus abdominis plane block on postoperative nausea and vomiting: a meta-analysis of randomized controlled trial. BMC Anesthesiol 24, 87 (2024). https://doi.org/10.1186/s12871-024-02469-x https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-024-02469-x#citeas
Copyright (c) 2025 Wayan Dhea Agastya, Amalia Rahmadinie, Fitri Sepviyanti Sumardi
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Jurnal Anestesi Obstetri Indonesia
