Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis

Abdallah, Faraj W.; Halpern, Stephen H.; Margarido, Clarita B.

doi:10.1093/bja/aes279

Cited by 180 publications

(99 citation statements)

References 44 publications

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“…In addition, as the cumulative fentanyl consumption was significantly lower in the T R S F and T RF groups at 2 h postoperatively, as compared with that in group T R , the early analgesic-sparing effect associated with perineural fentanyl may have been mediated by systemic effects due to peripheral uptake. The TAP block is commonly used during a cesarean delivery, in which it forms part of a multimodal postoperative analgesic regimen (2)(3)(4)(5). Previous studies have demonstrated that a single injection of TAP block was able to significantly improve post-cesarean analgesia in the absence of spinal morphine; however, the analgesic duration was limited, as compared with intrathecal morphine (2-4).…”

Section: Discussionmentioning

confidence: 99%

“…TAP block can be performed by injecting LAs into the tissue plane between the internal oblique and the transversus abdominis via a blind technique, based on surface anatomy landmarks (1,2) and, most recently, an ultrasound (US)-guided technique under direct vision (3,4). TAP block has been shown to effectively provide analgesia, without the requirement for intrathecal morphine, as part of a multimodal analgesic regimen following cesarean delivery (5). However, the duration of analgesia provided by a single-injection TAP block has been demonstrated to be shorter, as compared with that of the intrathecal morphine (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

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

Wang¹,

Liu²,

Zhang³

et al. 2016

Experimental and Therapeutic Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Wang¹,

Liu²,

Zhang³

et al. 2016

Experimental and Therapeutic Medicine

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show abstract

“…For example, a 2010 Cochrane Review of the analgesic effectiveness of TAP block after abdominal surgery included only five trials. 5 In 2012, Abdallah et al subsequently reported a systematic review and meta-analysis of TAP block for pain relief after Cesarean delivery that included results from five trials, 6 and in 2013, Champaneria et al…”

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confidence: 99%

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

131

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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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“…12 Additives to local anaesthetics like opioids, ketamine and α2 agonists like clonidine and dexmeditomidine have been successfully used in peripheral nerve blocks to increase the duration of postoperative analgesia. Various studies have been conducted for the post-operative analgesia in abdominal surgeries by comparing the transverses abdominis plane (TAP) block with placebo or local wound infilitration.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of efficacy of bupivacaine and bupivacaine plus clonidine in transversus abdominis plane (TAP) block for postoperative analgesia: a prospective, randomized, double blind, comparative study

Mir

Gani

et al. 2017

Int J Res Med Sci

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Background: Pain is the commonest symptom encountered postoperatively and hence multimodal analgesia is tried to overcome it. In this study, we have compared bupivacaine and bupivacaine plus clonidine in transversus abdominis plane (TAP) block for postoperative analgesia in patients undergoing lower abdominal surgeries under spinal anaesthesia. Methods: Sixty ASA I and II patients in the age range of 18-60 years undergoing various lower abdominal surgeries were randomly divided into two groups, who were operated after giving spinal block using 2.5 ml of 0.5% hyperbaric bupivacine and 25ug of fentanyl. At the end of surgical procedure tranversus abdominis plane (TAP) block was given by giving 25 ml of injection bupivacaine 0.25% in group I and 25 ml of 0.25% of bupivacaine with 1 ug.kg-1 of clonidine in group II. Quality of analgesia was assessed by visual analogue scale (VAS), categorical pain scoring system and frequency of rescue analgesia given and duration was assessed with the time at which first rescue analgesia was given. Side effects of clonidine such as sedation, bradycardia and hypotension were also noted. The hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were noted for both the groups. Results: Demographic characteristics like age, weight, sex, ASA class and type of surgeries were comparable in both groups. SBP, DBP and HR were less in group II than in group I and was statistically significant (p-value<0.05). The overall mean VAS score in group I was 3.03 ± 1.57 and group II was 1.72 ± 1.02 with p-value of 0.0005 and hence better quality of analgesia in group II. Categorical pain scoring system also showed statistically better scores in group II than group I. The duration of analgesia which was calculated by mean time for first rescue analgesia in group I was 6.38 ± 2.56 hours and group II was 14.23 ± 4.63 hours with a p-value of <0.0001 and the difference was statistically significant. The mean number of doses of rescue analgesia in group I for the first 24 hours was 1.37 ± 0.89 and in group II was 0.60 ± 0.62 with a p-value of 0.0003 and the difference was statistically significant. Group II patients showed more sedation scores than group I patients (p-value <0.05). None of the patients had any episode of bradycardia or hypotension. Conclusions: Addition of clonidine 1 ug.kg-1 to 25 ml of 0.25% bupivacaine compared to 25 ml of 0.25% bupivacaine alone in tranverse abdominis plane (TAP) block improves quality of analgesia, increases duration of postoperative analgesia and decreases postoperative analgesic requirements with minimal side effects.

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Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis

Cited by 180 publications

References 44 publications

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

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

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

Evaluation of efficacy of bupivacaine and bupivacaine plus clonidine in transversus abdominis plane (TAP) block for postoperative analgesia: a prospective, randomized, double blind, comparative study

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