Comparison of transversus abdominis plane block vs spinal morphine for pain relief after Caesarean section

McMorrow, R.C.N.; Mhuircheartaigh, R. J. Ni; Ahmed, Kaenat; Aslani, A.; Ng, Su Cheen; Conrick-Martin, Ian; Dowling, J.J.; Gaffney, Alan; Loughrey, J. P. R.; McCaul, Conán

doi:10.1093/bja/aer061

Cited by 153 publications

(180 citation statements)

References 24 publications

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“…4 Other studies confirmed the effectiveness after Caesarean section with lower pain scores, less opioid requirement and thereby fewer side effects. 11,[13][14][15] Even though the effect of TAP block as multimodal analgesia has been confirmed in different randomised clinical trials, 11,[13][14][15][16][17] whether posterior and lateral approach TAP block have differences in efficacy and duration of analgesic effect has remained controversial. However, in one meta-analysis study, the posterior TAP block technique appeared to have more prolonged analgesia effect than the lateral TAP block in lower abdominal significant (nausea 5.8% vs. 1.9%, p = 0.45 and vomiting 7.7% vs. 0%, p = 0.06) (see Table 2).…”

Section: Discussionmentioning

confidence: 99%

Transversus abdominis plane block after Caesarean section in an area with limited resources

Kahsay

Elsholz

Bahta

2017

Southern African Journal of Anaesthesia and Analgesia

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Background:The primary objective of this study was to assess whether transversus abdominis plane (TAP) block is effective as part of multimodal pain management following Caesarean section in an area with limited resources. The study also looked at the advantage of this block in reducing the consumption of morphine and diclofenac postoperatively. Methods: After approval by the institutional ethics committee and informed consent of participants, 108 ASA I and II patients for Caesarean section under spinal anaesthesia were randomly allocated to either the TAP block group or the control. The TAP block group received a landmark-orientated, bilateral TAP block in the triangle of Petit. Postoperative pain treatment followed the same protocol for both groups. Visual analogue scale (VAS) pain scores were measured at 2, 4, 6, 8, 12, 18 and 24 h postoperatively. At the same time, consumption of diclofenac and morphine was measured and compared. Results: No adverse effects of the TAP block were detected. VAS pain scores were significantly lower in the TAP block group at rest, deep breathing, intentional coughing, and mobilisation in all cases (p < 0. 05). Morphine and diclofenac consumption was significantly higher in the control group (p < 0. 001). Conclusion: TAP block reduced the VAS pain scores significantly both at rest and during stressors. As a result, morphine and diclofenac consumption was significantly reduced in the TAP block group. Therefore, it is feasible to implement TAP block as part of a multimodal analgesia regimen after Caesarean section in a tertiary health care centre in a developing nation.

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Section: Discussionmentioning

confidence: 99%

Transversus abdominis plane block after Caesarean section in an area with limited resources

Kahsay

Elsholz

Bahta

2017

Southern African Journal of Anaesthesia and Analgesia

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“…All the studies reported the 24-hr pain score, and 11 trials documented the 24-hr morphine consumption. 22,24,27,29,34,35,44,46,47,56,57 Transversus abdominal plane block did not significantly reduce the pain score (Table 2) at 24 hr but significantly reduced the mean 24-hr opioid consumption by 10 mg (95% CI, -17.4 to -2.8; P = 0.006) compared with the control group ( Table 2). The US-guided and landmark subgroup analyses for Cesarean delivery studies are presented in Table 3.…”

Section: Transversus Abdominal Plane Block Vs Local Infiltrationmentioning

confidence: 95%

“…[44][45][46][47] Use of ITM also reduced VAS score by 0.7 (95% CI, 0.3 to 1.1; P = 0.001) at six hours. Only one trial 45 evaluated the 12-hr pain score.…”

Section: Transversus Abdominal Plane Block Vs Intrathecal Morphinementioning

confidence: 96%

Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials

Brogi

Kazan

Cyr

et al. 2016

Can J Anesth/J Can Anesth

133

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Purpose The transversus abdominal plane (TAP) block has been described as an effective pain control technique after abdominal surgery. We performed a systematic review and meta-analysis of randomized-controlled trials (RCTs) to account for the increasing number of TAP block studies appearing in the literature. The primary outcome we examined was the effect of TAP block on the postoperative pain score at six, 12, and 24 hr. The secondary outcome was 24-hr morphine consumption. Source We searched the United States National Library of Medicine database, the Excerpta Medica database, and the Cochrane Central Register of Controlled Clinical Studies and identified RCTs focusing on the analgesic efficacy of TAP block compared with a control group [i.e., placebo, epidural analgesia, intrathecal morphine (ITM), and ilioinguinal nerve block after abdominal surgery]. Meta-analyses were performed on postoperative pain scores at rest at six, 12, and 24 hr (visual analogue scale, 0-10) and on 24-hr opioid consumption. Principal findings In the 51 trials identified, compared with placebo, TAP block reduced the VAS for pain at six hours by 1.4 (95% confidence interval [CI], -1.9 to -0.8; P\0.001), at 12 hr by 2.0 (95% CI, -2.7 to -1.4; P\0.001), and at 24 hr by 1.2 (95% CI, -1.6 to -0.8; P \ 0.001). Similarly, compared with placebo, TAP block reduced morphine consumption at 24 hr after surgery (mean difference, -14.7 mg; 95% CI, -18.4 to -11.0; P \0.001). We observed this reduction in pain scores and morphine consumption in the TAP block group after gynecological surgery, appendectomy, inguinal surgery, bariatric surgery, and urological surgery. Nevertheless, separate analysis of the studies comparing ITM with TAP block revealed that ITM seemed to have a greater analgesic efficacy. Conclusions The TAP block can play an important role in the management of pain after abdominal surgery by reducing both pain scores and 24-hr morphine consumption. It may have particular utility when neuraxial techniques or opioids are contraindicated. RésuméObjectif Le bloc dans le plan du muscle transverse de l'abdomen (ou TAP bloc) a été décrit comme une technique efficace de contrô le de la douleur après une chirurgie abdominale. Nous avons réalisé une revue systématique et une méta-analyse des études randomisées contrô lées (ERC) pour faire un état des lieux du nombre croissant d'études

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“…The type of analgesia provided by NSAIDs has been shown to be directed against the visceral cramping pain occurring after Cesarean delivery; 20,21 however, all three patients complained of predominantly somatic incisional pain (as opposed to visceral pain) for which TAP blocks are particularly indicated. [8][9][10] The analgesic efficacy of TAP blocks for these three women indicates that the pain was likely predominantly somatic incisional pain. Differentiation between incisional and cramping pain is important before offering TAP blocks as a rescue analgesic technique, as visceral pain from the uterus will not be adequately treated with TAP blocks.…”

Section: Discussionmentioning

confidence: 92%

“…6,7 Additionally, studies show that intrathecal morphine provides better post-Cesarean delivery analgesia compared with TAP blocks. 6,[8][9][10] The role of TAP block for rescue analgesia following surgery is not well described and poorly studied. Borglum et al describe a four-point TAP block technique as a rescue procedure in 25 patients who had undergone abdominal surgery other than Cesarean delivery under general anesthesia.…”

Section: Résumémentioning

confidence: 99%

Transversus abdominis plane blocks for rescue analgesia following Cesarean delivery: a case series

Mirza

Carvalho

2012

Can J Anesth/J Can Anesth

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Purpose The role of routine transversus abdominis plane (TAP) blocks at the time of surgery for Cesarean delivery analgesia is uncertain. Previous studies have shown no additional analgesic benefit in patients receiving intrathecal morphine. We present a series of three cases where TAP blocks were used for rescue analgesia in patients who had severe post-Cesarean delivery pain after a standard spinal anesthetic containing bupivacaine 12 mg, fentanyl 10 lg, and morphine 200 lg. Clinical features All three women experienced severe incisional pain in the postanesthetic care unit (PACU) after offset of spinal anesthesia. When the pain did not subside with intravenous opioids, the women were offered either additional intravenous opioids or a TAP block. They chose the latter. Bilateral TAP blocks were performed in a sterile posterior approach under ultrasound guidance with 0.375% ropivacaine 20 mL with epinephrine 1:400,000. All three patients experienced significant pain relief that lasted 10-19 hr and allowed for a timely discharge from the PACU. Conclusion These cases show that TAP blocks may play a valuable role as a rescue analgesic technique rather than as a routine preemptive block for all Cesarean delivery patients. Use of TAP blocks reduced the need for escalating intravenous opioid doses and potential maternal opioid-related side effects. Rescue TAP blocks should be considered after Cesarean delivery when intrathecal morphine does not provide adequate pain relief or for early breakthrough pain after offset of spinal anesthesia. RésuméObjectif Le rôle du bloc dans le plan du muscle transverse de l'abdomen (transversus abdominis plane block -TAP block) de routine pour l'analge´sie au moment de la chirurgie pour un accouchement par ce´sarienne est incertain. Les e´tudes pre´ce´dentes n'ont de´montre´aucun avantage analge´sique supple´mentaire chez les patientes recevant de la morphine intrathe´cale. Nous pre´sentons une se´rie de trois cas dans lesquels des TAP blocks ont e´te´utilise´s pour une analge´sie de secours chez des patientes qui souffraient de fortes douleurs apre`s un accouchement par ce´sarienne, pour lequel elles avaient reçu un anesthe´sique rachidien standard contenant de la bupivacaı¨ne 12 mg, du fentanyl 10 lg et de la morphine 200 lg. É léments cliniques Les trois femmes ont souffert de fortes douleurs au site d'incision en salle de re´veil, une fois l'effet de la rachianesthe´sie passe´. Lorsque la douleur ne s'est pas amenuise´e avec des opioı¨des intraveineux, on a propose´aux patientes des opioı¨des intraveineux supple´mentaires ou des TAP blocks, qu'elles ont choisi. Des TAP blocks bilate´raux ont e´te´re´alise´s par une approche poste´rieure ste´rile sous e´choguidage avec 20 mL de ropivacaı¨ne 0,375 % et 1:400 000 d'e´pine´phrine. Les trois patientes ont ressenti un soulagement important de la douleur d'une dure´e 10-19 h, ce qui a permis un conge´opportun de la salle de re´veil. Conclusion Ces cas de´montrent que les TAP blocks pourraient jouer un rôle pre´cieux en tant que te...

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Comparison of transversus abdominis plane block vs spinal morphine for pain relief after Caesarean section

Abstract: Spinal morphine-but not TAP block-improved analgesia after Caesarean section. The addition of TAP block with bupivacaine 2 mg kg(-1) to spinal morphine did not further improve analgesia.

Cited by 153 publications

References 24 publications

Transversus abdominis plane block after Caesarean section in an area with limited resources

Transversus abdominis plane block after Caesarean section in an area with limited resources

Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials

Transversus abdominis plane blocks for rescue analgesia following Cesarean delivery: a case series

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