Document Detail

The transversus abdominis plane block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve analgesia after cesarean delivery.
MedLine Citation:
PMID:  19916252     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVES: The transversus abdominis plane (TAP) block has been shown to provide analgesia for lower abdominal wall incisions. We evaluated the efficacy of the TAP block for post-cesarean delivery (CD) patients used as a part of a multimodal regimen. METHODS: Women undergoing elective CD under spinal anesthesia were randomized to receive the TAP block with ropivacaine (n = 50) or placebo (n = 50), in addition to a standard postoperative analgesic regimen inclusive of intrathecal opioids. At the end of the surgical procedure, all the patients received bilateral TAP blocks under real-time ultrasound guidance, with either 20 mL of ropivacaine 0.375% or saline, on each side. Each patient was assessed at 6, 12, 24, and 48 hrs postoperatively, and again 6 weeks after the surgical procedure. The primary outcome was the difference in visual analog scale pain scores with movement at 24 hrs postpartum. Other outcomes assessed were analgesic consumption, maternal satisfaction, and incidence of adverse effects. RESULTS: One hundred women were recruited, and 96 completed the study. The mean (SD) visual analog scale pain scores on movement at 24 hrs were not different between the ropivacaine and placebo groups (3.4 [2.4] and 3.2 [2.2] cm, respectively, P = 0.47). The pain scores at other times, and the supplemental opioid consumption, were also similar between the 2 groups. The overall incidence of pain at 6 weeks postpartum was 8.3%. CONCLUSIONS: The TAP block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve the quality of post-CD analgesia.
Joseph F Costello; Albert R Moore; Paul M Wieczorek; Alison J Macarthur; Mrinalini Balki; Jose C A Carvalho
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Regional anesthesia and pain medicine     Volume:  34     ISSN:  1532-8651     ISO Abbreviation:  Reg Anesth Pain Med     Publication Date:    2009 Nov-Dec
Date Detail:
Created Date:  2009-11-16     Completed Date:  2010-02-16     Revised Date:  2010-07-01    
Medline Journal Info:
Nlm Unique ID:  9804508     Medline TA:  Reg Anesth Pain Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  586-9     Citation Subset:  IM    
Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
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MeSH Terms
Abdominal Wall / surgery
Analgesia, Obstetrical / methods*
Analgesics, Opioid / administration & dosage
Anesthesia, Spinal / methods*
Anesthetics, Local
Cesarean Section / methods*
Double-Blind Method
Morphine / administration & dosage
Nerve Block / methods*
Pain Measurement
Patient Satisfaction
Treatment Outcome
Reg. No./Substance:
0/Amides; 0/Analgesics, Opioid; 0/Anesthetics, Local; 57-27-2/Morphine; 84057-95-4/ropivacaine
Comment In:
Reg Anesth Pain Med. 2010 Jul-Aug;35(4):404-5   [PMID:  20588155 ]
Reg Anesth Pain Med. 2010 May-Jun;35(3):324   [PMID:  20460979 ]

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