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Transversus abdominus plane block improves postoperative analgesia for cesarean following labor
Abstract Number: O1 3
Abstract Type: Original Research
Transversus abdominus plane (TAP) block alone has been demonstrated to be inferior to neuraxial morphine for postoperative pain relief following cesarean section. Additionally, preliminary studies have shown that TAP block as an adjunct to neuraxial morphine for scheduled cesarean does not improve postoperative pain relief. We hypothesized that laboring women who undergo cesarean have increased postoperative pain and the addition of a TAP block to our standard pain regimen would improve analgesia and decrease need for additional pain medications.
In this single-blinded, randomized controlled trial, 80 women undergoing cesarean section were enrolled to evaluate the added benefit of TAP block following neuraxial morphine. 40 women for elective cesarean and 40 women undergoing cesarean following labor were divided into a placebo group and a TAP group. An observer assessed the pain score and analgesic use over the next 24 hours. Total pain was the sum of all pain scores (area under the curve). The Mann-Whitney U test and the Kaplan Meier survival curve with log-rank analysis were used to analyze the results.
Demographic and obstetric factors were similar within delivery groups. In women who underwent cesarean following labor, TAP block significantly increased median time to supplemental analgesic when compared to placebo (75min vs 38min, p=0.02). Pain scores at 2 hours and Total pain were higher in the Placebo group, and they were more likely to require fentanyl in the PACU (P=0.02). among women undergoing scheduled cesarean, we found no difference for first analgesic (122mins vs 100mins, p=0.46) or need for fentanyl in PACU. Only pain scores at 4 hours were higher in the Placebo group (P<0.01). Among all placebo subjects, laboring women were more likely to have higher pain scores, earlier first analgesic, required more intraoperative supplementation, and received fentanyl in the PACU (P<0.5 for all) compared to scheduled cesarean. These were not statistically different among the TAP subjects.
The addition of a TAP block to the standard neuraxial morphine effectively reduced postoperative pain in women who underwent cesarean following labor, but not in women who underwent elective cesarean section. Laboring women who received a TAP block had similar pain control to scheduled cesarean women.