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Transvesus abdominus plane block for postoperative analgesia after Cesarean delivery in patients taking buprenorphine.
Abstract Number: T-58
Abstract Type: Original Research
Introduction: Post-partum patients pose unique challenges in the immediate postoperative period in regards to pain control. They desire a balance between being comfortable and being awake enough to care for their newborn. Within this population, women who are on opiate replacement therapy pose an even greater challenge, as they often require much higher doses of opioids in order to obtain relief resulting in unwanted side effects. Transversus Abdominus Plane (TAP) blocks have been shown to be efficacious for postoperative pain control following abdominal surgery. There has been no specific research regarding this form of analgesia in opioid tolerant obstetric patients. We evaluated the effect of TAP blocks in patients on buprenorphine and postoperative opioid consumption as well as pain scores in the first 24 hours following Cesarean section.
Methods: Eight patients on buprenorphine for opiate addiction presenting for cesarean delivery were randomly assigned to one of two groups: post-operative TAP block or sham block. All patients received spinal anesthesia with 12 mg bupivacaine and 15 mcg fentanyl for primary anesthetic. After surgery patients either received TAP block with 20 cc 0.5% ropivacaine, 4 mg dexamethasone, 1:200K epinephrine bilaterally or a sham block. All caregivers were blinded to study group except the anesthesia team providing the block. The primary outcome was total amount of opiate pain medication at 24 hrs. Secondary outcomes were pain scores and maternal satisfaction.
Results: Maternal satisfaction at 6 and 24 hours, pain scores at 24 hours and total morphine equivalents were calculated among the two groups. At 6 hours, the maternal satisfaction scores were higher in patients who received a TAP block compared to those who did not (mean score 9.75 out of 10 vs 6 out of 10, p=0.015.) At 24 hours maternal satisfaction was equivalent in both groups (mean score 7 out of 10, p=1) pain scores at 24 hours were also lower in patients who received a TAP block vs those that did not (mean score 5.75 out of 10 vs 7 out of 10, p=0.36.) Mean total morphine equivalents were also lower in the group who received the block compared to those who did not (108.6 mg vs 78.1 mg, p=0.47.)
Discussion: Maternal satisfaction at 6 hours following TAP block in this patient population was increased. A trend of lower opiate consumption was seen, however larger studies are needed to determine if this is a significant effect.