Intrathecal morphine currently represents the "gold standard" for providing effective post-cesarean analgesia, however, it causes many adverse effects. Multimodal analgesia reduces adverse effects. The objective of this study was to evaluate the effectiveness of multimodal analgesia by ultrasound-guided transversus abdominis plane block (TAP block) in combination with systemic analgesics after cesarean delivery (CS). Materials and method(:) In a randomized controlled clinical trial, 180 parturients after CS were randomly divided into 3 groups, respectively Para-TAP, Diclo-TAP and Para-Diclo. Group Para-TAP received paracetamol and TAP block, group Diclo-TAP received diclofenac and TAP block, group Para-Diclo received paracetamol and diclofenac. Pain intensity was assessed by using the visual analogue scale (VAS) at 1, 2, 4, 6, 8, 12, 18, 24 h and the functional activity score (FAS) during 24 h postoperatively. Five milligrams of morphine IV were reserved for rescue when VAS score at rest ≥ 4 or on movement ≥ 5. Results(:) Regarding VAS score, parturients with pain score up to 3 in group Para-TAP accounted for a high rate at rest and a low rate on movement, whereas group Diclo-TAP and Para-Diclo accounted for a high rate both at rest and on movement
group Para-TAP was more effective than group Para-Diclo in the period of 4 to 6 h
group Para-Diclo was more effective than group Para-TAP from 12 to 24 h
group Diclo-TAP was more effective than group Para-Diclo from 2 to 8 h. FAS score of A level in group Para-TAP accounted for 90% in the period from 1 to 8 h, more than 50% from 8 to 16 h, more than 60% from 16 to 24 h and 23.33% parturients required IV morphine rescue. FAS score of A level in group Diclo-TAP accounted for 100% in the period from 1 to 8 h, nearly 80% from 8 to 24 h and 10% parturients required IV morphine rescue. FAS score of A level in group Para-Diclo accounted for nearly 70% in the period from 1 to 16 h, nearly 90% from 16 - 24 h and 10% parturients required IV morphine rescue. Adverse effects were low rate and mild level in 3 groups. Conclusion(:) Group Para-TAP provided effective analgesia in the first 8 h, group Diclo-TAP in the 24 h, and better group Para-Diclo from from 2 to 8 h after CS. Adverse effects were low rate and mild in 3 groups.