Ultrasound-Guided Transversus Abdominis Plane Block versus Continuous Wound Infusion for Post-Caesarean Analgesia: A Randomized Trial

Abstract

ObjectiveTo compare the analgesic effect of ultrasound-guided Transversus Abdominis Plane (TAP) block versus Continuous Wound Infusion (CWI) with levobupivacaine after caesarean delivery.MethodsWe recruited parturients undergoing elective caesareans for this multicenter study. Following written informed consent, they received a spinal anaesthetic without intrathecal morphine for their caesarean section. The postoperative analgesia was randomized to either a bilateral ultrasound guided TAP block (levobupivicaine = 150 mg) or a CWI through an elastomeric pump for 48 hours (levobupivacaine = 150 mg the first day and 12.5 mg/h thereafter). Every woman received regular analgesics along with oral morphine if required. The primary outcome was comparison of the 48-hour area under the curve (AUC) pain scores. Secondary outcomes included morphine consumption, adverse events, and persistent pain one month postoperatively.ResultsRecruitment of 120 women was planned but the study was prematurely terminated due to the occurrence of generalized seizures in one patient of the TAP group. By then, 36 patients with TAP and 29 with CWI had completed the study. AUC of pain at rest and during mobilization were not significantly different: 50 [22.5–80] in TAP versus 50 [27.5–130] in CWI (P = 0.4) and 190 [130–240] versus 160 [112.5–247.5] (P = 0.5), respectively. Morphine consumption (0 [0–20] mg in the TAP group and 10 [0–32.5] mg in the CWI group (P = 0.09)) and persistent pain at one month were similar in both groups (respectively 29.6% and 26.6% (P = 0.73)).ConclusionIn cases of morphine-free spinal anesthesia for cesarean delivery, no difference between TAP block and CWI for postoperative analgesia was suggested. TAP block may induce seizures in this specific context. Consequently, such a technique after a caesarean section cannot be recommended.Trial RegistrationClinicalTrials.gov NCT01151943

Transversus Abdominis Plane (Tap) Block Versus Local Anesthetic Wound Infiltration (Lwi) for Post Total Abdominal Hysterectomy (Tah) Pain Relief.

“…In this trial we didn't recorded any systemic toxicity (14,23,24) of local anesthetic in both arms of our trial like reported in prematurely terminated study of Chandon et al (14) due to occurrence of generalized convulsions in women in TAP group. Also, Weiss et al (24) reported two patients with convulsion after TAP block in cesarean delivery.…”

“…However, trial comparing local wound infiltration with TAP block after other abdominal surgery as cesarean section were few (12,13,14,15) . Also, meta-analysis of trial comparing TAP block with wound infiltration after abdominal surgery were few (18,19) .…”

“…Few studies comparing TAP block and LWI for postoperative analgesia after cesarean section were existed (12,13,14,15) .…”

Effect of Transverse Abdominis Plane Block on Chronic Post-Operative Pain—A Review

“…Similarly, Chandon M. et al [38] In different abdominal surgeries, the effect of TAP Block has different effects on chronic post-operative pain. It may be due to the limited sample size of the patients, different surgical methods and different anatomy involved in different kind of surgery.…”

Postoperative analgesia after caesarean section with transversus abdominis plane block or continuous infiltration wound catheter: A randomized clinical trial. TAP vs. infiltration after caesarean section

“…To date, a randomized clinical study compared the efficacy of the two techniques but the study was prematurely ended because of severe adverse events in the TAP block group [14].…”