Intrathecal morphine versus transversus abdominis plane block for caesarean delivery: a systematic review and meta-analysis

Abstract

Background The number of caesarean deliveries has been increasing. Although intrathecal morphine (ITM) can relieve pain and is widely applied in caesarean deliveries, it is associated with many side effects. Transversus abdominis plane block (TAPB), a new analgesic technology, has also began playing a certain role after caesarean delivery, with fewer adverse effects. This study mainly compares the analgesic and adverse effects of ITM and TAPB in caesarean delivery. Methods We systematically searched PubMed, Cochrane Library, EMBASE, and Web of Science, for randomised controlled trials (RCTs) published before 9 October, 2020 to compare the effects of ITM and TAPB. Primary outcome of the study was the pain score at rest 24 h after caesarean delivery, whereas the secondary outcomes were the pain score at movement 24 h after operation, postoperative nausea and vomiting (PONV), itching, and morphine consumption. For the outcome assessment, we conducted a sensitivity analysis. Result Six RCTs involving 563 patients and meeting the study inclusion criteria were included in this study. Results indicated no significant difference in the pain score between ITM and TAPB at 24 h of rest or movement. The sensitivity analysis results indicated that the resting pain score (95% CI = − 1.27 to − 0.28; P = 0.002) and 24-h moving pain score (95% CI = − 1.8 to − 0.07; P = 0.03) of the ITM group were lower than those of the TAPB group. The consumption of morphine in the ITM group was lower than in the TAPB group (95% CI = 1.92 to 4.87; P < 0.00001); however, in terms of adverse reactions, the incidence of pruritus (95% CI = 1.17 to 8.26; P = 0.02) and PONV (95% CI = 1.92 to 4.87, P < 0.00001) in the ITM group was higher than in the TAPB group. Conclusion Parturients in the ITM and TAPB groups exhibited similar analgesic effects. However, in the sensitivity analysis performed by eliminating the studies causing heterogeneity, the ITM group was found to have superior analgesic effects compared with the TAPB group, with less morphine consumption. Differently, the TAPB group displayed less side effects such as PONV. Therefore, TAPB is still a valuable analgesia option for patients who cannot use ITM for analgesia after caesarean delivery or those having a high risk of PONV. Trial registration Registration number: Registered on Prospero with the registration number of CRD42020210135.

Effect of rectus sheath anaesthesia versus thoracic epidural analgesia on postoperative recovery quality after elective open abdominal surgery in a French regional hospital: the study protocol of a randomised controlled QoR-RECT-CATH trial

“…[19][20][21] Multiple meta-analyses, including seven conducted in the last 2 years, show that compared with placebo/conventional pain controls (4-36 randomised controlled trials (RCTs)), TAP block consistently associates with significantly less pain, morphine consumption and postoperative nausea/vomiting (PONV) in general or more specific abdominal surgical fields (eg, bariatric surgery). [22][23][24][25] The results are more equivocal when TAP block is compared with TEA in general abdominal or colorectal surgery (6-18 RCTs), with some finding no clinically significant difference in pain scores [26][27][28] but others reporting that TAP associates with better pain relief, morphine consumption, hypotension, length of stay (LOS) and PONV. 26 28 29 However, it should be noted that three of the four TAP versus TEA meta-analyses combined different TAP protocols, including unilateral/ bilateral and single-shot/continuous approaches: unilateral TAP may be insufficient to cover the surgical site while single-shot TAP may not be directly comparable to TEA, which is a continuous infusion.…”

“…It is a one-sided or two-sided injection of a local anaesthetic agent that targets the abdominal nervous branches from T6 to L1 19–21. Multiple meta-analyses, including seven conducted in the last 2 years, show that compared with placebo/conventional pain controls (4–36 randomised controlled trials (RCTs)), TAP block consistently associates with significantly less pain, morphine consumption and postoperative nausea/vomiting (PONV) in general or more specific abdominal surgical fields (eg, bariatric surgery) 22–25. The results are more equivocal when TAP block is compared with TEA in general abdominal or colorectal surgery (6–18 RCTs), with some finding no clinically significant difference in pain scores26–28 but others reporting that TAP associates with better pain relief, morphine consumption, hypotension, length of stay (LOS) and PONV 26 28 29.…”