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      Ultrasound-guided transversus abdominis plane block for analgesia after Caesarean delivery

      , , ,
      British Journal of Anaesthesia
      Oxford University Press (OUP)

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          Abstract

          The landmark-guided transversus abdominis plane (TAP) block is an effective method of providing postoperative analgesia in patients undergoing lower abdominal surgery. We evaluated the analgesic efficacy of the ultrasound (US)-guided TAP block in patients undergoing Caesarean delivery. A randomized, double-blind, placebo-controlled trial was performed at a tertiary maternity hospital. Fifty women undergoing Caesarean delivery received bilateral US-guided TAP blocks with either ropivacaine 0.5% or saline. All participants received a spinal anaesthetic with bupivacaine and fentanyl, followed by postoperative acetaminophen, non-steroidal anti-inflammatory drugs, and patient-controlled i.v. morphine without long-acting intrathecal opioids. Each patient was assessed 24 h after delivery for morphine usage, average pain score, nausea, vomiting, pruritus, drowsiness, and satisfaction with pain relief. Forty-seven participants completed the trial, 23 in the active group and 24 in the placebo group. Total morphine use in 24 h was reduced in the active group (median 18.0 mg) compared with the placebo group (median 31.5 mg, P<0.05). The active group reported improved satisfaction with their pain relief measured by visual analogue scale compared with the placebo group (median 96 vs 77 mm, P=0.008). Fewer patients required antiemetics in the active group (P=0.03). There were no local complications attributable to the TAP block, but one participant had an anaphylactoid reaction after ropivacaine injection. The US-guided TAP block reduces morphine requirements after Caesarean delivery when used as a component of a multimodal analgesic regimen. Registered with the Australia New Zealand Clinical Trials Registry ACTRN12608000540314. URL: http://www.anzctr.org.au/trial_view.aspx?ID=83176.

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          Author and article information

          Journal
          British Journal of Anaesthesia
          British Journal of Anaesthesia
          Oxford University Press (OUP)
          00070912
          November 2009
          November 2009
          : 103
          : 5
          : 726-730
          Article
          10.1093/bja/aep235
          19700776
          66d48cb9-3ba5-437c-a286-b69566c2ab63
          © 2009

          https://www.elsevier.com/tdm/userlicense/1.0/

          https://www.elsevier.com/open-access/userlicense/1.0/

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