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Transverse Abdominis plane block with Liposomal Bupivacaine for Analgesia After Cesarean Delivery
Abstract Number: T1A-4
Abstract Type: Original Research
Optimal pain control after major surgery contributes to a patient's recovery and satisfaction. Despite the early optimism, the utility of ultrasound-guided bilateral transversus abdominis plane (TAP) blocks as part of a multimodal analgesic regimen after CD remains uncertain. In patients undergoing (CD), TAP blocks with bupivacaine in patients who have received intrathecal morphine (ITM) has not been shown to be superior multimodal analgesic approach over ITM alone. However, TAP blocks with liposomal bupivacaine can theoretically provide an extended period of pain relief. Here at our institution, many patients have been routinely receiving liposomal bupivacaine in TAP blocks for both non-obstetric and obstetric surgical procedures. We conducted a retrospective study to determine whether the addition of liposomal bupivacaine to TAP blocks in patients receiving ITM provides a prolonged analgesic benefit beyond the initial 12 h after CD
We reviewed the electronic medical records of 33 patients. All received intravenous acetaminophen as well as spinal anesthesia with 0.75% bupivacaine, 1.6-1.8 mL, and preservative free morphine 0.1 mg. Eight patients additionally received bilateral TAP blocks with (10 cc of liposomal bupivacaine and 15 cc of bupivacaine 0.25%). Opioid consumption measured in mg of morphine equivalents (mEq) was evaluated at 6,12,18, 24, and 48h after CD and were compared between the two groups using the Wilcoxon-Mann-Whitney two-sample rank-sum test with p < 0.05 considered statistically significant.
The groups did not differ with regards to age, gestation, parity, BMI, or demographical data. Mean time to first opioid request was statistically prolonged in the group of patients receiving TAP blocks (1928 minutes versus 776 minutes in ITM group, p = 0.004). MEq consumption at 24 was significantly decreased in the TAP vs ITM group with a median use of 0 vs 22.5 mg, p = 0.033, respectively. Less opioid (MEq) consumption was also noted (favoring the TAP block group) at 48-hours after CD (see table 1).
Compared to patients who only received intrathecal morphine, patients who received ITM + bilateral TAP blocks with liposomal bupivacaine receive optimal analgesic benefit as demonstrated by prolonged time to first opioid request, as well as less total opioid consumption at 24 and 48h after CD.
J Clin Anesth 2013
Anesth Analg 2010