The Analgesic Efficacy of Subarachnoid Morphine in Comparison with Ultrasound-Guided Transversus Abdominis Plane Block After Cesarean Delivery

Abstract

As part of a multimodal analgesic regimen, subarachnoid morphine provided superior analgesia when compared with ultrasound-guided transversus abdominis plane block after cesarean delivery, yet at the cost of increased side effects.

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

“…27,28 After TAP block, differences in nausea and vomiting and pruritus were controversial in the literature, though most publications describe a higher incidence in the control groups for nausea and vomiting. 1,12,[14][15][16] Similarly, in our study, more patients in the control group had nausea and vomiting in the first 24 postoperative hours, though the difference was not statistically…”

“…NSAIDs were usually administered in a regular timebased manner. 14,15 In our study, we found a significant reduction of diclofenac consumption (40%, p < 0.001) in patients with TAP block as diclofenac was administered every 8 h only if a mother reported moderate to severe pain (VAS > 4 cm). As Abdallah et al 23 suggested, patients with conditions that prohibit them from taking NSAIDs (allergy, peptic ulcer, abnormal platelets and renal impairment) might benefit from TAP block.…”

“…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).…”

Eficácia analgésica do bloqueio ecoguiado do plano transverso do abdome – revisão sistemática

“…O TAP ecoguiado em cesariana foi avaliado em 10 ECR 19---27 ; entre elas foi avaliada em cesariana com anestesia espinhal em oito ECR 19---23,25,27 ; deles, quatro 20,22,23,27 compararam TAP vs. morfina espinal (MIT), dois compararam contra TAP placebo, 19,21 um deles avaliou a adição de O estudo se descreve como aleatorizado? Sim = 1 ponto; Não = 0 ponto O método usado para produzir a sequência aleatorizada é descrito e apropriado?…”

“…Adicionou-se adrenalina em três 22,37,45 e clonidina em um. 25 Unicamente em duas compararam-se concentrações diferentes de AL.…”