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High dose and low dose transversus abdominis plane block versus control for post-cesarean delivery analgesia - a meta-analysis
Abstract Number: T-59
Abstract Type: Meta Analysis/Review of the Literature
Introduction: Transversus abdominis plane (TAP) blocks provide effective analgesia after cesarean delivery (CD) but risk of local anesthetic toxicity (LAT) with large doses may be high due to physiological changes in pregnancy.1 This meta-analysis reports pain scores and opioid consumption in high dose (HD) and low dose (LD) TAP blocks for elective CD.
Methods: Online literature search identified 16 eligible RCTs examining post-CD analgesia after TAP block compared to control; HD was defined >50 mg bupivacaine equivalents per side, LD was ≤50 mg per side. Primary outcome was 24 hr opioid consumption (morphine equivalents). Secondary outcomes included: 6 hr opioid consumption, post-operative pain scores at rest and movement at 6 and 24 hrs. Mean difference (MD) and 95% confidence intervals were calculated using random effects modeling, HD and LD subgroups were compared using a Q test.
Results: 16 RCTs were included (1045 women; TAP group n=472; control group n=573). There was no difference in 24 hr opioid consumption between high and low dose groups (Figure 1). 6 hr pain scores were decreased compared with control in both TAP groups at rest (HD MD -11.11[-19.38, -2.84], p=0.008; LD MD -13.94[-25.88, -2.00], p=0.02) but were not different between HD and LD groups (p=0.70). 6 hr pain scores on movement were not statistically different in either TAP group compared with control (HD MD -12.53[-31.13, 6.07], p=0.19; LD MD -17.36[-38.41, 3.69], p=0.11), or between HD and LD groups (p=0.74). 24 hr pain scores at rest were not improved in HD or LD groups compared to control (HD MD -5.37[-14.74, 4.00], p=0.26; LD MD -4.63[-10.96, 1.69], p=0.15) and there was no difference between HD and LD groups (p=0.90). 24 hr pain scores on movement did not differ in both groups compared to control (HD MD -5.02[-21.46, 11.41], p=0.55; LD MD -13.21[-32.41, 5.99], p=0.18) and there was no difference between HD and LD groups (p=0.53).
Conclusion: This study demonstrates that LD TAP blocks provide equivalent analgesia and opioid sparing effects to HD blocks for CD. Findings suggest that lower doses (≤50mg bupivacaine equivalents per side) can be used to help reduce LAT risk without compromising analgesic efficacy.
1. Br J Anaesth. 2013;110:996-1000