Transversus abdominis plane block compared with wound infiltration for postoperative analgesia following Cesarean delivery: a systematic review and network meta-analysis

Sultan, Pervez; Patel, Sneh; Jadin, Sandra; Carvalho, Brendan; Halpern, Stephen H.

doi:10.1007/s12630-020-01818-x

Cited by 35 publications

(24 citation statements)

References 57 publications

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“…A total of 145 studies were included, of which 126 were randomised controlled trials and 19 were systematic reviews and meta‐analyses (Fig. 1) [9–153]. The methodological quality assessments of the 126 randomised controlled trials included in the final qualitative analysis are summarised in online Supporting Information Table S1.…”

Section: Resultsmentioning

confidence: 99%

“…However, in a direct comparison, a quadratus lumborum block was similar to intrathecal morphine [117]. Two recent meta-analyses evaluated TAP blocks, wound infusion and quadratus lumborum blocks with or without intrathecal morphine and concluded that all three regional anaesthetic techniques are superior to no regional technique in the absence of intrathecal morphine [120,121]. When intrathecal morphine is administered, adding these techniques confers no further advantages.…”

Section: Local and Regional Analgesia Techniquesmentioning

confidence: 99%

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PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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Caesarean section is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and patient satisfaction as well as breastfeeding success and mother-child bonding. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language between 1 May 2014 and 22 October 2020 evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane databases. Studies evaluating pain management for emergency or unplanned operative deliveries or caesarean section performed under general anaesthesia were excluded. A total of 145 studies met the inclusion criteria. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, recommendations include intrathecal morphine 50-100 µg or diamorphine 300 µg administered pre-operatively; paracetamol; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone administered after delivery. If intrathecal opioid was not administered, single-injection local anaesthetic wound infiltration; continuous wound local anaesthetic infusion; and/or fascial plane blocks such as transversus abdominis plane or quadratus lumborum blocks are recommended. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs with opioids used for rescue. The surgical technique should include a Joel-Cohen incision; non-closure of the peritoneum; and abdominal binders. Transcutaneous electrical nerve stimulation could be used as analgesic adjunct. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations. Some interventions were not recommended due to insufficient, inconsistent or lack of evidence. Of note, these recommendations may not be applicable to unplanned deliveries or caesarean section performed under general anaesthesia.

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Section: Resultsmentioning

confidence: 99%

Section: Local and Regional Analgesia Techniquesmentioning

confidence: 99%

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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“…2 In this issue of the Journal, Sultan et al present a network meta-analysis (NMA) comparing single-shot TAP block, single-dose wound infiltration (WI), and continuous wound catheter (WC) with a primary outcome of 24-hr opioid consumption after CD. 3 At first glance, it may be unclear from this study which technique is superior. Ultimately, TAP block finds the optimal balance of analgesic efficacy and feasibility.…”

mentioning

confidence: 85%

“…Le critère d'évaluation principal était la consommation d'opioïdes cumulative à 24 h après un accouchement par césarienne. 3 À première vue, il pourrait sembler difficile de déterminer quelle technique est supérieure. En bout de ligne, le bloc TAP permet d'atteindre l'équilibre optimal entre efficacité analgésique et faisabilité.…”

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Management of pain after Cesarean delivery without intrathecal morphine: networking for the best answer

Barry

Uppal

2020

Can J Anesth/J Can Anesth

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“…Original studies were eligible if they met the following criteria: (I) was an RCT study; (II) full text available in English; and (III) assessed the efficacy and safety of local anesthetic techniques for postoperative analgesia after cesarean delivery in the absence of intrathecal morphine (ITM) or other long-acting neuraxial opioids. 11 Original studies were ineligible if they were (I) reviews, observational studies, case-control studies, abstracts, letters, or case reports; (II) studies involving combination blocks (ie, TAPB and rectus sheath); (III) studies with adjuncts; or (IV) laboratory animal literature. In the case of several publications from the same study, the study with the greatest number of cases and most relevant information was included.…”

Section: Methodsmentioning

confidence: 99%

The Efficacy and Safety of Local Anesthetic Techniques for Postoperative Analgesia After Cesarean Section: A Bayesian Network Meta-Analysis of Randomized Controlled Trials

Wang¹,

Zhao²,

Song³

et al. 2021

JPR

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Objective Cesarean section (CS) is one of the most frequently performed major surgical interventions. Local anesthetic techniques, a universal component of perioperative multimodal analgesia, are reportedly effective in reducing pain scores and opioid requirements. However, the optimal local anesthetic technique for postoperative CS pain remains unclear. Methods Six databases were searched, and a Bayesian network meta-analysis was performed. The outcomes included cumulative morphine consumption and pain scores at four time points, time to first analgesic request, postoperative nausea and vomiting, pruritus, and sedation. Results Sixty-eight studies with 5039 pregnant women were included. Six local anesthetic techniques were involved, including transversus abdominis plane block (TAPB), ilioinguinal and iliohypogastric nerve block, quadratus lumborum blocks, transversalis fascia plane block, erector spinae block, and wound infiltration. Compared to inactive controls, TAPB reduced cumulative morphine consumption at 6, 12, 24, and 48 h, pain scores at 6, 12, and 24 h (with the exception of 24 h at rest), the risk of postoperative nausea and vomiting, and sedation. Compared with inactive controls, ilioinguinal and iliohypogastric nerve block reduced cumulative morphine consumption at 6 and 24 h and pain scores at 6, 12, and 24 h during movement. Compared with inactive controls, quadratus lumborum blocks reduced cumulative morphine consumption at 24 and 48 h and pain scores at 6 and 12 h and lengthened the time to first analgesic request. Compared with inactive controls, wound infiltration reduced cumulative morphine consumption at 12 and 24 h, pain scores at 12 and 24 h during movement, and risk of sedation. Compared with inactive controls, erector spinae block reduced pain scores at 6 and 12 h. Transversalis fascia plane block was found to have similar outcomes to inactive controls. Conclusion TAPB is the most comprehensive local anesthetic technique for postoperative CS analgesia in the absence of intrathecal morphine.

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Transversus abdominis plane block compared with wound infiltration for postoperative analgesia following Cesarean delivery: a systematic review and network meta-analysis

Cited by 35 publications

References 57 publications

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

Management of pain after Cesarean delivery without intrathecal morphine: networking for the best answer

The Efficacy and Safety of Local Anesthetic Techniques for Postoperative Analgesia After Cesarean Section: A Bayesian Network Meta-Analysis of Randomized Controlled Trials

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