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ULTRASOUND GUIDED TAP BLOCKS FOR POST-CESAREAN SECTION PAIN RELIEF: A PILOT STUDY
Abstract Number: 73
Abstract Type: Case Report/Case Series
A pilot study was carried out to assess the feasibility and efficacy of bilateral USG TAP blocks for post cesarean section (CS) pain relief at 24h in term parturients.
After obtaining the REB approval, we carried out an unblinded prospective study of two non-randomized cohorts of 10 patients each. Informed consent was obtained from each patient. Adult women with an ASA score of 1-2 that were at term gestation with singleton fetuses were included. These women were booked for elective CS under spinal anesthesia. Patients with BMI > 40, history of chronic pain, opioid dependency, substance abuse or allergy to local anesthetic were excluded. All women received spinal bupivacaine 0.75% (10-12 mg), fentanyl (10-15 mcg) and epidural morphine (100 - 150 mcg). They were also given standard postoperative multimodal analgesia in a PRN basis, which included NSAIDs, acetaminophen and codeine. The patients in the TAP block group received USG bilateral TAP blocks with ropivacaine 0.5%, 3 mg/kg, with a max. dose of 60 ml or 300 mg total at the end of the CS. Block levels were assessed 4 hours after spinal placement. Pain scores (with rest & movement) in both groups were recorded at 24h.
Baseline characteristics including age, BMI, parity, and previous CS were similar between groups. The pain scores in the TAP block group vs. the control group at 24h at rest were 0.8 (1.03) vs. 3.3 (1.4) respectively (p value = 0.0003). The pain scores in the TAP block group vs. the control group at 24h with movement were 2.9(1.2) vs. 6.1 (0.9) respectively, (p value= 0.0001). The epidural morphine used was similar in both groups, 115 mg (SD 33.7) in the TAP block group and 140 mg (SD 45.9) in the control group (p value = 0.18). The total codeine consumption at 24h was less in the TAP block group compared to the control group: 102 mg (40.5) vs. 147 mg (45.7) respectively (p value = 0.031). The time for the first request of codeine was longer in the TAP block group compared with the control group: 17.8 h (1.5) vs.16.2h (1.9) respectively, (p value= 0.007). The TAP blocks were easily carried out with no complications and in an average time of 12 minutes. Average sensory block levels to ice at 4h were T10.
In this pilot study, bilateral US guided TAP blocks were feasible and effective for post CS pain relief in term parturients.
TAP Block, Pain relief, Cesarean section