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Transversus Abdominal Plane Block Using Liposomal Bupivacaine in an Obstetric Patient on Chronic Buprenorphine Therapy Undergoing Cesarean Section
Abstract Number: RF1BA-191
Abstract Type: Case Report Case Series
Patients with a history of opioid abuse and chronic pain are often managed with chronic buprenorphine therapy. The partial agonist properties of buprenorphine prohibit full activation of the opioid receptor even when full agonists are used. This presents a challenge to the anesthesiologist because opioid-based analgesic regimens for perioperative pain are often the mainstay. With the growing opioid epidemic, the need for opioid-free analgesic adjuncts is increasingly evident. The transversus abdominis plane (TAP) block utilizing liposomal bupivacaine represents one such adjunct. We present a case in which liposomal bupivacaine was used in a TAP block performed on a patient on chronic buprenorphine therapy undergoing Caesarean section and provided 3 days of excellent pain control.
A 28 year old G3 P1011 at female with a history of IV heroin abuse presented to Labor and Delivery for an elective repeat Cesarean section at 39 weeks and 1 day gestation. She had been on chronic buprenorphine therapy since the first month of her pregnancy and had not used heroin since that time. She underwent an uneventful Caesarean delivery and received bilateral TAP blocks with liposomal bupivacaine post-operatively. During the first three post-operative days she reported good pain control and required no intravenous opioid. She received only one dose of oral opioid during this time.
Several studies have shown the effectiveness of TAP blocks in providing analgesia and decreasing need for post-operative opioids1-4. There have not been any large studies investigating TAP blocks using liposomal bupivacaine specifically in patients on buprenorphine undergoing Caesarean section. In this case, we were able to limit post-operative opioid use and still provide adequate analgesia for 72 hours post-operatively. We believe that the technique described in this case shows promise as a way to provide opioid-free analgesia to this opioid-vulnerable population.
1) Fayezizadeh M, Majumder A, Neupane, R, et al. Efficacy of transversus abdominis plane block with liposomal bupivacaine during open abdominal wall reconstruction. Am J Surg. 2016. 212(3): 399-405.
2) Baeriswyl M, Kirkham KR, Kern C, et al. The Analgesic Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block in Adult Patients: A Meta-Analysis. Anesth Analg. 2015; 121(6): 1640-1654
3) Mishriky BM, George RB, Habib AS: Transversus abdominis plane block for analgesia after Caesarean delivery: a systematic review and meta-analysis. Can J Anaesth. 2012; 59(8): 766-78.
4) Abdallah FW, Halpern SH, Margarido CB, et al. Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis. Br J Anaesth. 2012; 109(5): 679-87.