J Anesth Perioper Med. 2019;6(1):15-22. https://doi.org/10.24015/ebcmed.japm.2019.0004
From the 1Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; 2Department of Anesthesia, Lurie Children’s Hospital, Chicago, IL, USA; 3Roper St. Francis Mount Pleasant Hospital, Mount Pleasant, SC, USA; 4Geisinger Medical Center, Danville, PA, USA; 5Franciscan Health, Indianapolis, IN, USA.
Correspondence to Dr. Philip E. Hess at firstname.lastname@example.org.
EBCMED ID: ebcmed.japm.2019.0004 DOI: 10.24015/ebcmed.japm.2019.0004
Transversus abdominis plane (TAP) block has been studied for pain control after elective cesarean delivery and has a limited role. The TAP block has not been studied after cesarean delivery for women who attempted to go through labor. We hypothesized that women have greater postoperative discomfort after prolonged labor and that a TAP block might improve analgesia.
In this single-blinded, randomized controlled trial, 40 women having a cesarean delivery following labor were randomized into a placebo or ultrasound-guided TAP block using 0.25% bupivacaine. We also enrolled 40 women undergoing elective cesarean delivery as the second comparator group to assess TAP block efficacy. A blinded investigator assessed the pain scores in the post anesthesia care unit (PACU) and at 2, 4, 8, and 24 h postoperatively and recorded analgesic use over the first 24 hours. The primary outcome measure was the time to first supplemental analgesic request, which was typically ketorolac.
In women who underwent cesarean following labor, the median time to the first analgesic request was significantly longer in TAP cohort compared to placebo (75 (interquartile range [IQR], 50-142) min vs. 38 [IQR, 16-70] min, P = 0.02). The placebo group had higher pain scores at 2 hours, 8 hours, summary 24-hour pain scores, and were more likely to require fentanyl in the PACU (0% vs. 25%, P = 0.02). Among women undergoing elective cesarean, we found no difference in the time to first analgesic request (122 [IQR, 80-505] min vs. 100 [IQR, 75-172] min, P = 0.46) or need for fentanyl in PACU. Only pain scores at 4 hours were higher in the Placebo group (P < 0.01).
Women who undergo cesarean following labor may benefit from the addition of a TAP block to the standard neuraxial morphine. Women for scheduled cesarean may not receive benefit from routine use of a TAP block. (Funded by the Beth Israel Anesthesia Foundation, Boston, USA.)
Declaration of Interests
The authors have no other potential conflicts of interest for this work.
This study was supported by a grant from the Beth Israel Anesthesia Foundation (internal departmental funding), Boston, USA.
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