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Comparing TAP block and wound infiltration for post-operative analgesia following cesarean delivery: A meta-analysis
Abstract Number: S2B-1
Abstract Type: Original Research
Introduction: Transversus abdominis plane (TAP) block local anesthesia and wound infiltration both provide benefits following cesarean delivery. Although few studies directly compare the analgesic efficacy of these two techniques, several studies have compared either TAP or WI to placebo making indirect comparisons feasible. The aim of this meta-analysis was to compare analgesic efficacy of TAP block with WI when used in the absence of intrathecal morphine for cesarean delivery.
Methods: Literature searches were performed to identify randomized controlled trials comparing the analgesic effects of (1) TAP block with WI (2) TAP block with placebo (3) WI with placebo, for cesarean delivery without intrathecal morphine. The primary outcome was standardized mean difference (SMD) of visual analogue score (VAS) at 12 hours. Direct comparisons of TAP vs. WI were computed. The same outcomes for TAP vs. placebo and WI vs. placebo were then calculated. Secondary outcomes included: incidence of nausea and vomiting, 24 hour opioid consumption and maternal sedation. Point estimates of 95% confidence intervals were derived using random effects modelling. A p value of <0.05 was considered statistically significant.
Results: Seventeen studies met out inclusion criteria comprised of 1117 patients. Direct comparisons of pain scores at 12 hours included 205 patients in the TAP group and 207 patients in the WI group and showed no statistical difference between the two techniques (-0.069 [-0.128, -0.266]; p=0.495). Indirect comparison of pain scores at 12 hours included 578 patients in the TAP group and 539 patients in the WI group, and also showed no statistical difference between the two techniques (-0.43 [-0.89, 0.04]; p=0.07). Subgroup analysis showed that TAP block significantly reduced pain scores at 12 hours compared to placebo (-0.99 [-1.75, -0.11]; p=0.03), but pain scores at 12 hours were not reduced with WI compared to placebo (-0.19 [-0.75, 0.38]; p=0.52). Direct comparison of TAP block and WI demonstrated no differences in the incidence of nausea and vomiting (1.123 [0.509, 2.478]; p=0.7), 24 hour opioid consumption (-0.07 [-0.365, 0.212]; p=0.6) or maternal sedation (0.734 [0.345, 1.578]; p=0.432).
Discussion: We could not demonstrate a statistically significant difference in analgesia or side effects between the TAP block or WI for cesarean delivery. Both TAP block or WI could be considered as part of a multimodal analgesia for parturients who have not received intrathecal morphine.
1. Champaneria R, Shah L, Wilson MJ et al. Clinical effectiveness of transversus abdominis plane (TAP) block for pain relief after caesarean section: a meta-analysis. Int J Obstet Anesth. 2016; 28: 45-60
2. Bamigboye AA, Hofmeyr GJ. Local anaesthetic wound infiltration and abdominal nerve blocks during caesarean section for pain relief. Cochrane Database Syst Rev. 2009; 8(3): CD006954