///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-06:00


Abstract Number: 170
Abstract Type: Original Research

Christopher R Cambic M.D.1 ; Cynthia A Wong M.D.2; Robert J McCarthy Pharm.D.3

Introduction: Breakthrough pain during the first 12 hours after cesarean delivery (CD) occurs in some patients who have received intrathecal (IT) morphine. Recent studies suggest that the TAP block, as part of a multimodal postoperative pain regimen, provides superior pain relief.1,2 However, there are no published reports investigating the analgesic impact of the TAP block on patients receiving IT morphine. Therefore, we performed a retrospective pilot study to test the hypothesis that the incidence of breakthrough pain is lower in patients who received TAP block compared to no TAP block as part of multimodal post-CD analgesia.

Methods: For this IRB-approved study, 30 patients who received a TAP block (0.5% ropivacaine, 15 mL per side) after IT morphine 150 g as part of a spinal anesthetic for elective CD (TAP group), between 10/2008 and 12/2008, were identified. These patients were compared to 30 patients during the same time period who received IT morphine, but no TAP block (Control). All patients received ketorolac 30 mg IV q6 h for at least 12 hours after delivery and could request acetaminophen (APAP)/hydrocodone and ibuprofen for treatment of breakthrough pain. Medical records for these patients were reviewed using a standard data sheet. Collected data included time of IT morphine administration, time to first request for APAP/hydrocodone, cumulative 24, 48, and 72 h hydrocodone and ibuprofen consumption, and 24 and 48 h ketorolac consumption, in addition to demographic data.

Results: A total of 60 patients were included. Demographic data was significant for a higher gestational age in the TAP group (39 1/7 w) v. the control group (37 6/7 w)(P <0.01). There was no difference in consumption between the two groups at any time period for any of the study medications (Table). There was no difference in median time to first request for APAP/hydrocodone between groups (TAP 15.8 h; Control 16.0 h)(P = 0.23).

Discussion: Results of this study suggest that the administration of a TAP block postoperatively in women who received IT morphine for CD provides no additional analgesic benefit in terms of 72 h cumulative opioid or NSAID consumption, or time to first request for opioid rescue medication. However, the true postoperative analgesic impact of the TAP block in this study may be underestimated due to underdosing of ketorolac in the TAP group during the first 24 h.

1. Anesth Analg 2008;106:186-91

2. Anesth Analg 2007;104:193-7

SOAP 2009