Transversus abdominis plane block for analgesia after Cesarean delivery: a systematic review and meta-analysis

Mishriky, Basem M.; George, Ronald B.; Habib, Ashraf S.

doi:10.1007/s12630-012-9729-1

Cited by 190 publications

(157 citation statements)

References 34 publications

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“…16 The role of TAP blocks at the time of surgery for postCesarean delivery analgesia has been studied. 1,6 The utility of a TAP block as an additional analgesic intervention in women undergoing Cesarean delivery under spinal anesthesia with intrathecal morphine (and multimodal with NSAIDs and acetaminophen) appears limited. 1,6,7 A recent editorial and a meta-analysis suggest that the current role of TAP blocks at the time of Cesarean delivery may be limited to women who do not receive intrathecal morphine.…”

Section: Discussionmentioning

confidence: 99%

“…1,6 The utility of a TAP block as an additional analgesic intervention in women undergoing Cesarean delivery under spinal anesthesia with intrathecal morphine (and multimodal with NSAIDs and acetaminophen) appears limited. 1,6,7 A recent editorial and a meta-analysis suggest that the current role of TAP blocks at the time of Cesarean delivery may be limited to women who do not receive intrathecal morphine. 6,17 In our view, the role of TAP blocks in the setting of Cesarean delivery (with intrathecal morphine and multimodal analgesia) may be better suited as a rescue analgesic technique for those women who have severe breakthrough pain following surgery, rather than as a routine block in all patients at the time of Cesarean delivery.…”

Section: Discussionmentioning

confidence: 99%

“…1,6,7 A recent editorial and a meta-analysis suggest that the current role of TAP blocks at the time of Cesarean delivery may be limited to women who do not receive intrathecal morphine. 6,17 In our view, the role of TAP blocks in the setting of Cesarean delivery (with intrathecal morphine and multimodal analgesia) may be better suited as a rescue analgesic technique for those women who have severe breakthrough pain following surgery, rather than as a routine block in all patients at the time of Cesarean delivery. These three cases show the utility for TAP blocks as a technique to manage breakthrough pain after Cesarean delivery with intrathecal morphine, and they confirm the efficacy of rescue TAP blocks described following abdominal (non-Cesarean delivery) surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Pain and analgesic consumption have been found to be reduced in patients with TAP blocks at the time of Cesarean delivery under spinal anesthesia without intrathecal morphine; 4-6 however, minimal additional analgesic benefit is found in women receiving intrathecal morphine with multimodal analgesia. 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.…”

Section: Résumémentioning

confidence: 99%

“…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%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

See 3 more Smart Citations

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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Quality of pain treatment after caesarean section: Results of a multicentre cohort study

Marcus

Gerbershagen

Peelen

et al. 2014

European Journal of Pain

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In daily clinical practice, pain after CS is much higher than previously thought. Pain management was insufficient compared with patients undergoing hysterectomy. Unfavourable outcome was mainly associated with low opioid administration after CS. Contradictory pain treatment guidelines for patients undergoing CS and for breastfeeding mothers might contribute to reluctance of opioid administration in CS patients.

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Postoperative pain control and opioid use with transversus abdominis plane block and scheduled multimodal pain management in patients undergoing cesarean section

Richards,

Dunn,

Chellappa

et al. 2024

Intl J Gynecology & Obste

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ObjectiveThe impact of a transversus abdominis plane (TAP) block in patients undergoing cesarean section requires further evaluation. The aim of this study was to compare postoperative pain scores and opioid use in cesarean surgery patients undergoing either a TAP block and scheduled multimodal pain management (SMPM) or SMPM alone.MethodsIn this retrospective, dual cohort study, cesarean surgery patients underwent neuraxial anesthesia and a TAP block (SMPM/TAP) or SMPM; the TAP block incorporated ropivacaine (20–30 mL) administered bilaterally. The group analyses involved a comparison of postoperative pain scores using the visual analog scale and opioid consumption at 24 and 24–48 h.ResultsThere were 94 (52.8%) patients in the SMPM/TAP group and 84 (47.2%) subjects in the SMPM alone group. At 24 h postoperatively, the SMPM/TAP group exhibited significantly lower pain scores (4.07 vs 4.54) than the SMPM group (P < 0.001) and reduced opioid consumption (2.29 vs 3.28 mg; P < 0.001). However, at 24–48 h, the SMPM group demonstrated lower pain scores (5.46 vs 5.98) compared to the SMPM/TAP group (P < 0.001) and reduced opioid consumption (8.75 vs 10.21 mg; P < 0.001); overall opioid consumption was higher (12.50 vs 12.02 mg) in the SMPM/TAP group (P < 0.001).ConclusionThe TAP block improved cesarean surgery patients' pain scores and reduced opioid consumption at 24 h postoperatively but the effect of the TAP block was ephemeral as the SMPM/TAP group exhibited inferior pain scores and greater opioid consumption compared to the SMPM group at 24–48 h postoperatively.

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Transversus abdominis plane block for analgesia after Cesarean delivery: a systematic review and meta-analysis

Cited by 190 publications

References 34 publications

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

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

Quality of pain treatment after caesarean section: Results of a multicentre cohort study

Postoperative pain control and opioid use with transversus abdominis plane block and scheduled multimodal pain management in patients undergoing cesarean section

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