A randomised trial of the analgesic efficacy of ultrasound-guided transversus abdominis plane block after caesarean delivery under general anaesthesia

Tan, T.; Teoh, Wendy H.; Woo, David; Ocampo, Cecilia E.; Shah, Manish K.; Sia, Angelia

doi:10.1097/eja.0b013e32834f015f

Cited by 94 publications

(83 citation statements)

References 13 publications

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“…All the studies reported the 24-hr pain score, and 11 trials documented the 24-hr morphine consumption. 22,24,27,29,34,35,44,46,47,56,57 Transversus abdominal plane block did not significantly reduce the pain score (Table 2) at 24 hr but significantly reduced the mean 24-hr opioid consumption by 10 mg (95% CI, -17.4 to -2.8; P = 0.006) compared with the control group ( Table 2). The US-guided and landmark subgroup analyses for Cesarean delivery studies are presented in Table 3.…”

Section: Transversus Abdominal Plane Block Vs Local Infiltrationmentioning

confidence: 94%

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Le bloc dans le plan du muscle transverse de l’abdomen pour réaliser une analgésie postopératoire: revue systématique et méta-analyse des études randomisées contrôlées

Brogi

Kazan

Cyr

et al. 2016

Can J Anesth/J Can Anesth

124

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Purpose The transversus abdominal plane (TAP) block has been described as an effective pain control technique after abdominal surgery. We performed a systematic review and meta-analysis of randomized-controlled trials (RCTs) to account for the increasing number of TAP block studies appearing in the literature. The primary outcome we examined was the effect of TAP block on the postoperative pain score at six, 12, and 24 hr. The secondary outcome was 24-hr morphine consumption. Source We searched the United States National Library of Medicine database, the Excerpta Medica database, and the Cochrane Central Register of Controlled Clinical Studies and identified RCTs focusing on the analgesic efficacy of TAP block compared with a control group [i.e., placebo, epidural analgesia, intrathecal morphine (ITM), and ilioinguinal nerve block after abdominal surgery]. Meta-analyses were performed on postoperative pain scores at rest at six, 12, and 24 hr (visual analogue scale, 0-10) and on 24-hr opioid consumption. Principal findings In the 51 trials identified, compared with placebo, TAP block reduced the VAS for pain at six hours by 1.4 (95% confidence interval [CI], -1.9 to -0.8; P\0.001), at 12 hr by 2.0 (95% CI, -2.7 to -1.4; P\0.001), and at 24 hr by 1.2 (95% CI, -1.6 to -0.8; P \ 0.001). Similarly, compared with placebo, TAP block reduced morphine consumption at 24 hr after surgery (mean difference, -14.7 mg; 95% CI, -18.4 to -11.0; P \0.001). We observed this reduction in pain scores and morphine consumption in the TAP block group after gynecological surgery, appendectomy, inguinal surgery, bariatric surgery, and urological surgery. Nevertheless, separate analysis of the studies comparing ITM with TAP block revealed that ITM seemed to have a greater analgesic efficacy. Conclusions The TAP block can play an important role in the management of pain after abdominal surgery by reducing both pain scores and 24-hr morphine consumption. It may have particular utility when neuraxial techniques or opioids are contraindicated. RésuméObjectif Le bloc dans le plan du muscle transverse de l'abdomen (ou TAP bloc) a été décrit comme une technique efficace de contrô le de la douleur après une chirurgie abdominale. Nous avons réalisé une revue systématique et une méta-analyse des études randomisées contrô lées (ERC) pour faire un état des lieux du nombre croissant d'études

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Section: Transversus Abdominal Plane Block Vs Local Infiltrationmentioning

confidence: 94%

“…Pain scores at six and 12 hr were investigated in 23 and 18 [16][17][18][19][20][21][22][23]25,26,29,31,32,[34][35][36][38][39][40][41] studies, respectively. The overall analyses showed that, in the TAP block group, the six-hour VAS pain score was reduced by 1.4 (95% CI, -1.9 to -0.8; P \ 0.001) (Fig.…”

Section: Transversus Abdominal Plane Block Vs Placebomentioning

confidence: 99%

Le bloc dans le plan du muscle transverse de l’abdomen pour réaliser une analgésie postopératoire: revue systématique et méta-analyse des études randomisées contrôlées

Brogi

Kazan

Cyr

et al. 2016

Can J Anesth/J Can Anesth

124

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“…Similar to us, these investigators did not use PCA in their patients. In another study on patients who underwent CD under general anesthesia, Tan et al (17) reported similar outcomes; they observed a significant decrease in morphine use in the TAP block group, whereas VAS scores were not different between patients in the TAP block and standard care groups. In their study, principal component analysis was implemented as a routine standard of practice, whereas such protocol is not in use in our institution.…”

Section: Discussionmentioning

confidence: 74%

Comparison of bilateral transversus abdominis plane block and wound infiltration with bupivacaine for postoperative analgesia after cesarean delivery

Görkem¹,

Koçyiğit²,

Toğrul³

et al. 2017

J Turkish German Gynecol AssocJ Turkish German Gynecol Assoc

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Objective:The study aimed to compare efficacy, safety, pain intensity and analgesic consumption in patients receiving either bilateral transversus abdominis plane (TAP) block or wound infiltration with bupivacaine after cesarean delivery (CD).Material and Methods:A total of 216 parturient women undergoing CD under general anesthesia were randomly allocated into five groups: i) controls (group 1), ii) TAP placebo (group 2), iii) TAP (group 3), iv) wound infiltration placebo (group 4), and, v) wound infiltration (group 5). Pain intensity was assessed using a visual analogue scale (VAS). Analgesic consumptions were recorded by a blinded nurse at 6, 12, and 18 hours postoperatively.Results:The baseline characteristics of the five groups were similar in terms of age, history of CD, and body mass indices (p>0.05). There were significant intergroup differences in VAS scores between all groups at the zero time-point (p=0.03), at the 6th hour (p=0.02), 12th hour (p=0.02), and at the 18th hour (p=0.02). Group 3 patients had lower pain scores and consumed less diclofenac than group 2 patients only within 12 hours postoperatively whereas pain intensity and analgesic consumption were not different between group 5 and group 4 patients. Group 5 patients received significantly less pethidine than group 4 and group 1 patients (p<0.001).Conclusion:TAP block provided better pain relief and less analgesic requirement than bupivacaine wound infiltration early after CD. Given the similar amounts of diclofenac but lower amounts of pethidine administered in the wound infiltration group, wound infiltration of bupivacaine seems promising in terms of reducing opioid use after CD under general anesthesia, especially when TAP block is not used.

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“…[1819202122232425262728293031] Most of the investigators used ultrasound-guided TAP block; only in two studies TAP block was performed by anatomical landmark technique. [2021]…”

Section: Regional Nerve Infiltration Technique: Transversus Abdominismentioning

confidence: 99%

“…[182122] In two of these studies, CS was performed under general anaesthesia while in the third study spinal anaesthesia was administered. However, when compared to ITM, TAP block was reported to be ineffectual in three studies.…”

Section: Regional Nerve Infiltration Technique: Transversus Abdominismentioning

confidence: 99%

Post-caesarean analgesia: What is new?

2017

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A randomised trial of the analgesic efficacy of ultrasound-guided transversus abdominis plane block after caesarean delivery under general anaesthesia

Abstract: Ultrasound-guided transversus abdominis plane block reduced morphine consumption following caesarean section under general anaesthesia, with increased maternal satisfaction.

Cited by 94 publications

References 13 publications

Le bloc dans le plan du muscle transverse de l’abdomen pour réaliser une analgésie postopératoire: revue systématique et méta-analyse des études randomisées contrôlées

Le bloc dans le plan du muscle transverse de l’abdomen pour réaliser une analgésie postopératoire: revue systématique et méta-analyse des études randomisées contrôlées

Comparison of bilateral transversus abdominis plane block and wound infiltration with bupivacaine for postoperative analgesia after cesarean delivery

Post-caesarean analgesia: What is new?

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