A randomized controlled trial comparing intrathecal morphine with transversus abdominis plane block for post-cesarean delivery analgesia

Loane, H.; Preston, R.; Douglas, M.J.; Massey, S.; Papsdorf, M.; Tyler, J.

doi:10.1016/j.ijoa.2012.02.005

Cited by 103 publications

(120 citation statements)

References 21 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: 95%

“…[44][45][46][47] Use of ITM also reduced VAS score by 0.7 (95% CI, 0.3 to 1.1; P = 0.001) at six hours. Only one trial 45 evaluated the 12-hr pain score.…”

Section: Transversus Abdominal Plane Block Vs Intrathecal Morphinementioning

confidence: 95%

“…All four trials investigated 24-hr pain scores; there was no statistical difference in the VAS scores obtained using ITM vs TAP block (Table 2). Intrathecal morphine, however, showed significantly reduced opioid consumption 44,46,47 by 7.7 mg (95% CI, -1.9 to -13.5; P = 0.009) in comparison with TAP block (Table 2). It was not possible to perform subgroup analysis for this comparison.…”

Section: Transversus Abdominal Plane Block Vs Intrathecal Morphinementioning

confidence: 97%

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Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials

Brogi

Kazan

Cyr

et al. 2016

Can J Anesth/J Can Anesth

130

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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: 95%

“…[44][45][46][47] Use of ITM also reduced VAS score by 0.7 (95% CI, 0.3 to 1.1; P = 0.001) at six hours. Only one trial 45 evaluated the 12-hr pain score.…”

Section: Transversus Abdominal Plane Block Vs Intrathecal Morphinementioning

confidence: 95%

Section: Transversus Abdominal Plane Block Vs Intrathecal Morphinementioning

confidence: 97%

See 1 more Smart Citation

Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials

Brogi

Kazan

Cyr

et al. 2016

Can J Anesth/J Can Anesth

130

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“…The type of analgesia provided by NSAIDs has been shown to be directed against the visceral cramping pain occurring after Cesarean delivery; 20,21 however, all three patients complained of predominantly somatic incisional pain (as opposed to visceral pain) for which TAP blocks are particularly indicated. [8][9][10] The analgesic efficacy of TAP blocks for these three women indicates that the pain was likely predominantly somatic incisional pain. Differentiation between incisional and cramping pain is important before offering TAP blocks as a rescue analgesic technique, as visceral pain from the uterus will not be adequately treated with TAP blocks.…”

Section: Discussionmentioning

confidence: 95%

“…6,7 Additionally, studies show that intrathecal morphine provides better post-Cesarean delivery analgesia compared with TAP blocks. 6,[8][9][10] The role of TAP block for rescue analgesia following surgery is not well described and poorly studied. Borglum et al describe a four-point TAP block technique as a rescue procedure in 25 patients who had undergone abdominal surgery other than Cesarean delivery under general anesthesia.…”

Section: Résumémentioning

confidence: 99%

Transversus abdominis plane blocks for rescue analgesia following Cesarean delivery: a case series

Mirza

Carvalho

2012

Can J Anesth/J Can Anesth

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Purpose The role of routine transversus abdominis plane (TAP) blocks at the time of surgery for Cesarean delivery analgesia is uncertain. Previous studies have shown no additional analgesic benefit in patients receiving intrathecal morphine. We present a series of three cases where TAP blocks were used for rescue analgesia in patients who had severe post-Cesarean delivery pain after a standard spinal anesthetic containing bupivacaine 12 mg, fentanyl 10 lg, and morphine 200 lg. Clinical features All three women experienced severe incisional pain in the postanesthetic care unit (PACU) after offset of spinal anesthesia. When the pain did not subside with intravenous opioids, the women were offered either additional intravenous opioids or a TAP block. They chose the latter. Bilateral TAP blocks were performed in a sterile posterior approach under ultrasound guidance with 0.375% ropivacaine 20 mL with epinephrine 1:400,000. All three patients experienced significant pain relief that lasted 10-19 hr and allowed for a timely discharge from the PACU. Conclusion These cases show that TAP blocks may play a valuable role as a rescue analgesic technique rather than as a routine preemptive block for all Cesarean delivery patients. Use of TAP blocks reduced the need for escalating intravenous opioid doses and potential maternal opioid-related side effects. Rescue TAP blocks should be considered after Cesarean delivery when intrathecal morphine does not provide adequate pain relief or for early breakthrough pain after offset of spinal anesthesia. RésuméObjectif Le rôle du bloc dans le plan du muscle transverse de l'abdomen (transversus abdominis plane block -TAP block) de routine pour l'analge´sie au moment de la chirurgie pour un accouchement par ce´sarienne est incertain. Les e´tudes pre´ce´dentes n'ont de´montre´aucun avantage analge´sique supple´mentaire chez les patientes recevant de la morphine intrathe´cale. Nous pre´sentons une se´rie de trois cas dans lesquels des TAP blocks ont e´te´utilise´s pour une analge´sie de secours chez des patientes qui souffraient de fortes douleurs apre`s un accouchement par ce´sarienne, pour lequel elles avaient reçu un anesthe´sique rachidien standard contenant de la bupivacaı¨ne 12 mg, du fentanyl 10 lg et de la morphine 200 lg. É léments cliniques Les trois femmes ont souffert de fortes douleurs au site d'incision en salle de re´veil, une fois l'effet de la rachianesthe´sie passe´. Lorsque la douleur ne s'est pas amenuise´e avec des opioı¨des intraveineux, on a propose´aux patientes des opioı¨des intraveineux supple´mentaires ou des TAP blocks, qu'elles ont choisi. Des TAP blocks bilate´raux ont e´te´re´alise´s par une approche poste´rieure ste´rile sous e´choguidage avec 20 mL de ropivacaı¨ne 0,375 % et 1:400 000 d'e´pine´phrine. Les trois patientes ont ressenti un soulagement important de la douleur d'une dure´e 10-19 h, ce qui a permis un conge´opportun de la salle de re´veil. Conclusion Ces cas de´montrent que les TAP blocks pourraient jouer un rôle pre´cieux en tant que te...

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Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery

Andreae

2012

Cochrane Database of Systematic Reviews

101

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Background Regional anaesthesia may reduce the rate of persistent (chronic) pain after surgery, a frequent and debilitating condition. Objectives To compare local anaesthetics and regional anaesthesia versus conventional analgesia for the prevention of persistent pain six or 12 months after surgery. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), PubMed (1966 to April 2012), EMBASE (1966 to May 2012) and CINAHL (1966 to May 2012) without any language restriction. We used a combination of free text search and controlled vocabulary search. The results were limited to randomized controlled clinical trials (RCTs). We conducted a handsearch in reference lists of included trials, review articles and conference abstracts. Selection criteria We included RCTs comparing local anaesthetics or regional anaesthesia versus conventional analgesia with a pain outcome at six or 12 months after surgery. Data collection and analysis Two authors independently assessed trial quality and extracted data, including information on adverse events. We contacted study authors for additional information. Results are presented as pooled odds ratios (OR) with 95% confidence intervals (CI), based on random-effects models (inverse variance method). We grouped studies according to surgical interventions. We employed the Chi2 test and calculated the I2 statistic to investigate study heterogeneity. Main results We identified 23 RCTs studying local anaesthetics or regional anaesthesia for the prevention of persistent (chronic) pain after surgery. Data from a total of 1090 patients with outcomes at six months and of 441 patients with outcomes at 12 months were presented. No study included children. We pooled data from 250 participants after thoracotomy, with outcomes at six months. Data favoured regional anaesthesia for the prevention of chronic pain at six months after thoracotomy with an OR of 0.33 (95% CI 0.20 to 0.56). We pooled two studies on paravertebral block for breast cancer surgery; the pooled data of 89 participants with outcomes at five to six months favoured paravertebral block with an OR of 0.37 (95% CI 0.14 to 0.94).The methodological quality of the included studies was intermediate. Adverse effects were not studied systematically and were reported sparsely. Clinical heterogeneity, attrition and sparse outcome data hampered the assessment of effects, especially at 12 months. Authors’ conclusions Epidural anaesthesia may reduce the risk of developing chronic pain after thoracotomy in about one patient out of every four patients treated. Paravertebral block may reduce the risk of chronic pain after breast cancer surgery in about one out of every five women treated. Our conclusions are significantly weakened by performance bias, shortcomings in allocation concealment, considerable attrition and incomplete outcome data. We caution that our evidence synthesis is based on only a few, small studies. More studies with high methodological quality, addre...

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A randomized controlled trial comparing intrathecal morphine with transversus abdominis plane block for post-cesarean delivery analgesia

Cited by 103 publications

References 21 publications

Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials

Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials

Transversus abdominis plane blocks for rescue analgesia following Cesarean delivery: a case series

Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery

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