Addition of fentanyl to the ultrasound-guided transversus abdominis plane block does not improve analgesia following cesarean delivery

Abstract

Abstract. The present study aimed to investigate whether the addition of fentanyl to the transversus abdominis plane (TAP) block procedure may improve analgesic duration following cesarean delivery. A total of 147 nulliparous women with an American Society of Anesthesiologists physical status I-II, scheduled for elective cesarean delivery under spinal anesthesia, were enrolled in the present study. All patients underwent cesarean delivery under spinal anesthesia with 10 mg bupivacaine and 10 µg fentanyl, after which the patients underwent an ultrasound-guided bilateral TAP block with either 0.375% ropivacaine (group T R ; n=48), 0.375% ropivacaine and 50 µg subcutaneous fentanyl (group T R S F ; n=49), or a mixture of 0.375% ropivacaine and 50 µg fentanyl (2.5 µg/ml; group T RF ; n=50) per side. The TAP block formed part of a multimodal analgesic regimen comprising patient-controlled analgesia (PCA) with intravenous fentanyl, and regular treatment with diclofenac and paracetamol. The TAP block was performed in the midaxillary line using an in-plane technique. The primary outcome was the time to the first PCA, whereas secondary outcomes were the cumulative and interval PCA consumptions, visual analogue scale (VAS) pain scores at rest and during movement, side effects assessed at 2, 6, 12, 24 and 48 h postoperatively, and patient satisfaction with postoperative analgesia. No significant differences were observed in the median time to the first PCA among the three groups (P=0.640), which were 150 min (70-720 min) in group T R , 165 min (90-670 min) in group T R S F , and 190 min (70-680 min) in group T RF . Fentanyl consumption, VAS pain scores, side effects and patient satisfaction were similar among the three groups; however, the demand for fentanyl was significantly decreased in the T R S F and T RF groups at 2 h postoperatively (P=0.001 and 0.002, respectively), as compared with group T R . No complications attributed to the TAP block were detected. In conclusion, the results of the present study suggested that the addition of 2.5 µg/ml fentanyl to the TAP block procedure was unable to improve analgesia following cesarean delivery under spinal anesthesia.

Evaluation of Fentanyl as an Adjuvant to Bupivacaine in Ultra Sound Guided Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Abdominal Hysterectomy

“…In Wang LZ et al study, when Fentanyl was added to ropivacaine in ultrasound guided TAP block for caesarean section under subarachnoid block, there was no improvement in postoperative pain outcome and no significant differences in the postoperative nausea and vomiting sedation levels. 7 In our study, the sedation scores were higher in group BF compared to Group B at 0-hour, 2hour, 4-hour, 6-hour, 12-hour and 24-hour. The difference in Sedation scores, between Group BF and Group B was statistically significant at 4-hour (p= 0.01 < 0.05).…”

“…Many adjuvants including fentanyl have been studied for local anaesthetics to extend the duration of postoperative analgesia following regional blocks. 7 Aims and Objectives The current study was done to evaluate as to whether Fentanyl as an adjuvant to local anaesthetic bupivacaine improves the quality and duration postoperative analgesia of transversus abdominis plane block in abdominal hysterectomy.…”

Comparative study of ropivacaine versus dexmedetomidine-ropivacaine combination in transversus abdominis plane block for postoperative pain control in plastic surgery patients undergoing abdominoplasty

“…Addition of fentanyl to ropivacaine for TAP block after cesarean section in one study did not show any effect on mean time to first use of PCA, overall use of PCA, or in postoperative VAS scores when compared to use of ropivacaine alone. 13 Combination of dexamethasone to ropivacaine (Dex-R) for TAP blocks has also yielded inconsistent results in different studies. In one study, TAP block after inguinal hernia repair with Dex-R was associated with lower pain score at 24 hours postop and lower morphine use in the first 24 hours after surgery.…”

Post-caesarean analgesia: What is new?

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

“…These included adding clonidine or fentanyl and increasing the dose of LA, but all of them failed to show any benefit. [242730] When TAP block was compared as a part of multimodal analgesia comprising epidural morphine, less consumption of patient-controlled analgesia (PCA) morphine was noted. [28] In two other studies, TAP block was observed to be equally effective in comparison to wound infiltration for analgesia.…”