DR SAMI TRAD'S ORIGINAL "PROGRAMMED METHOD OF PAINLESS CHILBIRTH"
BY INJECTION OF TAC (TRAD ANALGESIC COCKTAIL).
What is TAC analgesia?
This is a method of obstetrical analgesia devised in the year 1961 by Dr Sami Trad in Trad Hospital.
It became popular under the name "إبرة طراد"
Why did this Trad Method become quickly popular?
It was easy to administer and very efficient. Overall it appeared at a time when no other successful method of obstetrical analgesia was available in Lebanon or abroad.
What other methods of obstetrical analgesia were in use at the time Trad Method was started?
There were the psychological methods (Read, Vervovsky, Lamaze) which enjoyed a great popularity around 1940 and by 1960 had shown their limits and started to fall in discredit.
Of the pharmaceutical methods in use at this time such as the paracervical block, the pudendal block, the injection of opioïds or of Gamma globulin, none had proven satisfactory.
As for the epidural analgesia, it had just started in the USA and was practically unknown in Europe. Even in 1988, only 7% of deliveries in France were made with peridural analgesia.
What does Trad method of obstetrical analgesia (the TAC algesia) consist of?
It consists simply in the administration during the course of labor of a specially devised lytic cocktail given by means of 1 or 2 intramuscular injections followed by 3 to 5 intravenous injections during the course of labor.
What are the components of this cocktail?
There are several components given in varying proportions, basically potentiating their effects and suppressing their side effects: Opiates, Phenothiazines, Scopolamine, Ephedrine, respiratory analeptics (Nalorphine and Vectarion). Hyaluronidase is used as a vector for the IM route.
Why did epidural analgesia progress nowadays so much at the expense of other analgesia methods?
After 1960, epidural analgesia started to improve and spread from USA to Europe and Lebanon. Although keeping in mind its limitations: 20% of failures, definite contraindications for its use (obese women, women with spinal problems, women with coagulation problems or with skin infections in the back). And also its side effects (chronic back pain, temporary bladder paralysis and other neurological symptoms).
In spite of all these drawbacks and disadvantages the peridural became very popular because it favored and facilitated the enormous increase in the rate of cesarean sections (from 10% in 1960 to over 60% today reaching even 100% with some gynecologists). The reason for the increased success of epidural analgesia among obstetricians was that it could be used as analgesic to soothe labor pains as well as an anesthetic for C-sections. So the patient, if already motivated by her obstetrician was practically and psychologically ready to undergo a cesarean section. Statistics show that for parturients receiving peridural analgesia the c-sections rate is three times bigger than in women receiving other kind of analgesia or no analgesia at all (French statistics).
Did the Trad Analgesia continue its expansion in Lebanon and outside?
It was welcome in Europe and especially in Germany where, among others, professor Semm, Chairman of Kiel University, acknowledged the method and wished to adopt it there. Also, International conferences were held with success in Berlin and Saarbruck. In London a book was published at Barker Edition entitled: Painless Programmed Childbirth. In Lebanon, because of the Lebanese Civil War, the momentum of the method was broken, since Dr Trad was busy defending his hospital situated in the no-man's land between warring East and West Beirut and was cut from his patients mainly from East Beirut.
What is the future of Trad Obstetrical Analgesia?
Aside from its intrinsic qualities and its obvious advantages over peridural (no limitations or restrictions of the analgesia results, no contraindications, no side effects) the one tremendous advantage of the Trad analgesia over epidural consists in the simplicity of its use, no anesthetist being needed for its IM/IV administration, which makes it the method of choice in all small maternities mainly in rural areas where no anesthetist is available. It is also the method of choice for women who wish to deliver whenever possible in the Sanapa way, that is safely and naturally (without a much greater risk of having an operative or instrumental delivery) and an easier and surer painless childbirth since there is no need for an anesthetist - often unavailable - to achieve that purpose.
It is besides the ideal method for anxious women, some suffering from anxiety neurosis and who for this reason cannot even bare the experience of delivery but it is also fair to admit that for some women on the contrary it is important to stay completely awake during childbirth and to "participate in a way" in the process. I do not agree with this view for the simple reason that a very painful childbirth cannot be considered as a joyful experience. On the other hand, choosing a peridural analgesia, will lead in 60% of the cases to a cesarean section, in which a woman cannot "participate" in the process.
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