Intraoperative TAP Block as an Alternative to Ultrasound-Guided TAP Block After Cesarean Sections [7D

Abstract

INTRODUCTION: To determine whether intraoperative TAP (transverse abdominis plane) block (I-TAP) will reduce the time needed to perform the block without increasing pain scores when compared to the percutaneous ultrasound-guided approach (U-TAP). METHODS: We performed a randomized clinical-trial to compare the time to perform I-TAP and U-TAP for post C-Section analgesia and consequent pain scores. We recruited 41 women undergoing elective cesarean-delivery under neuraxial-anesthesia, and randomly assigned them to receive either U-TAP or I-TAP. U-TAP was performed by the anesthesiologist using a 21-guage blunt-tipped nerve block needle to inject 20 mL of 0.5% ropivacaine transcutaneously in the TAP-plane on each side under ultrasound-guidance. I-TAP was performed intraoperatively by the obstetrician by approaching the TAP-plane from inside the abdominal wall (transperitoneal-approach) using the same needle and drug. Time taken to perform the procedure, 24 hour morphine consumption and postoperative pain on VAS (visual analog scale) at rest and on coughing at 4, 8, and 24 hours was recorded. RESULTS: There was no significant difference in 24 hours morphine consumption (28±16.8 mg versus 38.4±23.8 mg, P=.12) and postoperative pain scores at 4, 8 and 24 hours at rest (4±2.7 versus 4.2±2.8, P=.99; 4±2.5 versus 3.6±2, P=.98; 3±2.7 versus 2.3±2.3, P=.29) and on coughing (6±3.4 versus 6.5±2.7, P=.68; 6±3.4 versus 5.4±2.6, P=.57; 6±3.3 versus 4.7±2.4, P=.15) between the two groups. However, the time taken to perform I-TAP was less than the time taken to perform U-TAP (2.4±0.5 minutes vs 12.3±5 minutes, P<.001). CONCLUSION: The intraoperative approach to the TAP block is less time consuming and does not require ultrasound-guidance while providing comparable postoperative analgesia after cesarean-delivery.