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Review Meta Analysis Comparative Study
Transversus abdominis plane block for analgesia after Cesarean delivery: a systematic review and meta-analysis.
In patients not receiving intrathecal morphine, TAP block after caesarean section reduced opioid use at 6, 12 and 24 hours, along with nausea at 12h.
pearl- Basem M Mishriky, Ronald B George, and Ashraf S Habib.
- Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710, USA.
- Can J Anaesth. 2012 Aug 1; 59 (8): 766-78.
PurposeTo assess the efficacy of transversus abdominis plane (TAP) block in improving analgesia following Cesarean delivery (CD).SourceWe searched MEDLINE, CENTRAL, EMBASE, and CINAHL for randomized controlled trials that assessed the efficacy of TAP block following CD and reported on postoperative pain scores and/or opioid consumption. Studies were combined according to the use or non-use of intrathecal morphine (ITM). Another analysis was performed for studies comparing TAP block with ITM.Principal FindingsNine studies were included. Transversus abdominis plane block significantly reduced opioid consumption (mg morphine equivalents) after Cesarean delivery at six hours (mean difference [MD] -10.18; 95% confidence interval [CI] -13.03 to -7.34), at 12 hr (MD -13.83; 95% CI -22.77 to -4.89), and at 24 hr (MD -20.23; 95% CI -33.69 to -6.77). The TAP block also reduced pain scores for up to 12 hr and nausea in patients who did not receive ITM. When added to ITM, TAP block produced a small reduction in pain scores on movement in the first six hours (MD -0.82, 95% CI -1.52 to -0.11). When compared with ITM, pain scores on movement and opioid consumption at 24 hr were lower (MD 0.98; 95% CI 0.06 to 1.91 and MD 8.42 mg; 95% CI 1.74 to 15.10, respectively), and time to first rescue analgesic was longer with ITM (8 hr vs 4 hr), although opioid-related side effects were more common.ConclusionTransversus abdominis plane block significantly improved postoperative analgesia in women undergoing CD who did not receive ITM but showed no improvement in those who received ITM. Intrathecal morphine was associated with improved analgesia compared with TAP block alone at the expense of an increased incidence of side effects.
This article appears in the collections: How effective is the Transversus Abdominis Plane (TAP) Block?, Regional blocks, and Regional stuff.
Notes
Important to note that the 9 studies included for meta-analysis (524 patients in total) were quite heterogenous: 7 performed under spinal anaesthesia and 2 under general; TAP performed using anatomical landmarks in 3 and ultrasound in 6; spinals used various doses of fentanyl and/or morphine; and the TAP blocks used ropivacaine (4), bupivacaine (4) or levobupivacaine (1). Post-operative analgesic regimes also varied.
Thus these findings should be cautiously applied to your local setting.
Daniel Jolley
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