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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

Efficacy of ultrasound guided transversus abdominis plane blocks for post-Cesarean section analgesia: a double blind, dose comparison, placebo controlled randomized clinical trial

Abstract Number: O1 5
Abstract Type: Original Research

Sudha I Singh MD FRCPC1 ; Kristine Marmai MD FRCPC2; Shalini Dhir MD3; Sarah Rehou BSc (hon)4; Marcos Silva MD5; Carol Bradbury MD FRCA6

Background: The analgesic benefit of transversus abdominis plane (TAP) blocks for cesarean delivery (CD) pain remains controversial. We compared the analgesic efficacy of two doses of local anaesthetic TAP blocks after (CD).

Methods: Sixty women having CD under standardised spinal anesthesia were randomized to receive ultrasound guided TAP blocks with either high dose ropivacaine (3mg/kg), low dose ropivacaine (1.5 mg/kg) or placebo. Patients received bupivacaine 0.75% (10-12 mg), fentanyl (10 mcg) and morphine (150 mcg) and standard multimodal analgesia. The primary outcome was the difference in pain with movement using a numeric rating scale at 24h. Other outcomes included pain scores at 6, 12, 36, 48, 72 hours and at 6 and 12 weeks as well as time to first request for analgesics, opioid consumption, adverse effects, quality of recovery, and satisfaction.

Results: There were no differences between groups in the primary outcome. Mean (SD) pain scores with movement at 24 h were: high dose ropivacaine 3.6 (1.5), low dose ropivacaine 4.6 (2.1) and placebo 4.1 (1.7). With respect to secondary outcomes, the mean (SD) pain scores at 6 h were lower in the high dose group {2.0 (1.8)}, compared to the low dose {3.4 (2.7)} and placebo groups {4.2 (2.0)}, [p=0.009]. Pain scores at 12 h were also lower in the high dose group {2.2 (2.0)} compared to the low dose group {4.1 (2.7)} and placebo group {4.0 (1.3)} [p=0.011]. There was no difference in other outcomes between groups.

Conclusions: Neither high dose nor low dose TAP blocks as part of multimodal analgesia inclusive of intrathecal morphine improved pain scores with movement at 24h after CD when compared to placebo TAP blocks. However, high dose TAP blocks may improve pain scores up to 12h after CD.

SOAP 2013