Postoperative analgesia after caesarean section with transversus abdominis plane block or continuous infiltration wound catheter: A randomized clinical trial. TAP vs. infiltration after caesarean section

• Published in: Anaesthesia critical care & pain medicine 2016-12, Vol.35 (6), p.401-406
• Main Authors: Klasen, Fanny, Bourgoin, Aurélie, Antonini, François, Dazeas, Emma, Bretelle, Florence, Martin, Claude, Baumstarck, Karine, Leone, Marc
• Format: Article
• Language: English
• Subjects: Abdominal Muscles; Adult; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Anesthesia & Perioperative Care; Anesthesia, Local - methods; Anesthetics, Local - administration & dosage; Caesarean; Catheterization; Cesarean Section; Double-Blind Method; Economics and Finance; Female; Human health and pathology; Humanities and Social Sciences; Humans; Infiltration; Life Sciences; Morphine - administration & dosage; Morphine - therapeutic use; Nerve Block - adverse effects; Nerve Block - methods; Pain; Pain Measurement - drug effects; Pain, Postoperative - drug therapy; Parturient; Postoperative Nausea and Vomiting - epidemiology; Pregnancy; Prospective Studies; Psychiatrics and mental health; Psychology; Santé publique et épidémiologie; TAP; Treatment Outcome
• ISSN: 2352-5568; 2352-5568
• DOI: 10.1016/j.accpm.2016.02.006

Abstract Objective Single shot transversus abdominis plane (TAP) block and continuous local anesthetic infiltration wound catheter (CLAIWC) decreased the morphine consumption after caesarean section. The aim of this study was to compare the analgesic efficacy of CLAIWC and ultrasound-guided TAP block. Method Sixty patients undergoing caesarean section were prospectively randomized. After the caesarean section, the postoperative analgesia was randomized to either a CLAIWC localized below the fascia with an elastomeric pump for 48 hours or a bilateral ultrasound-guided TAP block with injection of ropivacaine. Every patient had a morphine pump patient-controlled analgesia. The primary outcome was the morphine consumption during the first 48 hours. Secondary outcomes were pain score levels, adverse effects of opioids, and patient satisfaction. Variables were collected during 48 hours after the caesarean section. Results Median cumulative 48-hour morphine consumption was 17 [8–51] mg in the TAP group versus 21 [7–34] mg in the CLAIWC group ( P = 0.3). We did not find a difference between the groups regarding pain, side effects and satisfaction scores. Conclusion As part of a multimodal analgesic regimen, there is no significant difference between the TAP block and CLAIWC for postoperative analgesia after a caesarean section.