• D M Narasimhulu, L Scharfman, H Minkoff, B George, P Homel, and K Tyagaraj.
• The Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA; The Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: drdeepamaheswari@gmail.com.
• Int J Obstet Anesth. 2018 Aug 1; 35: 26-32.

BackgroundInjection of local anesthetic into the transversus abdominis plane (TAP block) decreases systemic morphine requirements after abdominal surgery. We compared intraoperative surgeon-administered TAP block (surgical TAP) to anesthesiologist-administered transcutaneous ultrasound-guided TAP block (conventional TAP) for post-cesarean analgesia. We hypothesized that surgical TAP blocks would take less time to perform than conventional TAP blocks.MethodsWe performed a randomized trial, recruiting 41 women undergoing cesarean delivery under neuraxial anesthesia, assigning them to either surgical TAP block (n=20) or conventional TAP block (n=21). Time taken to perform the block was the primary outcome, while postoperative pain scores and 24-hour opioid requirements were secondary outcomes. Student's t-test was used to compare block time and Kruskal-Wallis test opioid consumption and pain-scores.ResultsTime taken to perform the block (2.4 vs 12.1 min, P <0.001), and time spent in the operating room after delivery (55.3 vs 77.9 min, P <0.001) were significantly less for surgical TAP. The 24 h morphine consumption (P=0.17) and postoperative pain scores at 4, 8, 24 and 48 h were not significantly different between the groups.ConclusionSurgical TAP blocks are feasible and less time consuming than conventional TAP blocks, while providing comparable analgesia after cesarean delivery.Copyright © 2018 Elsevier Ltd. All rights reserved.

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