Abstract
ObjectiveTo compare the analgesic effect of ultrasound-guided Transversus Abdominis Plane (TAP) block versus Continuous Wound Infusion (CWI) with levobupivacaine after caesarean delivery.MethodsWe recruited parturients undergoing elective caesareans for this multicenter study. Following written informed consent, they received a spinal anaesthetic without intrathecal morphine for their caesarean section. The postoperative analgesia was randomized to either a bilateral ultrasound guided TAP block (levobupivicaine = 150 mg) or a CWI through an elastomeric pump for 48 hours (levobupivacaine = 150 mg the first day and 12.5 mg/h thereafter). Every woman received regular analgesics along with oral morphine if required. The primary outcome was comparison of the 48-hour area under the curve (AUC) pain scores. Secondary outcomes included morphine consumption, adverse events, and persistent pain one month postoperatively.ResultsRecruitment of 120 women was planned but the study was prematurely terminated due to the occurrence of generalized seizures in one patient of the TAP group. By then, 36 patients with TAP and 29 with CWI had completed the study. AUC of pain at rest and during mobilization were not significantly different: 50 [22.5–80] in TAP versus 50 [27.5–130] in CWI (P = 0.4) and 190 [130–240] versus 160 [112.5–247.5] (P = 0.5), respectively. Morphine consumption (0 [0–20] mg in the TAP group and 10 [0–32.5] mg in the CWI group (P = 0.09)) and persistent pain at one month were similar in both groups (respectively 29.6% and 26.6% (P = 0.73)).ConclusionIn cases of morphine-free spinal anesthesia for cesarean delivery, no difference between TAP block and CWI for postoperative analgesia was suggested. TAP block may induce seizures in this specific context. Consequently, such a technique after a caesarean section cannot be recommended.Trial RegistrationClinicalTrials.gov NCT01151943
Highlights
Caesarean delivery is one of the most commonly performed surgical procedures and postoperative pain is a great concern for women [1]
Two recent meta-analyses have shown the efficacy of single shot bilateral Transversus Abdominis Plane (TAP) block [5,6] after caesarean section while another demonstrated the usefulness of local anesthetic agent with Continuous Wound Infiltration (CWI) during a few days [7]
Only 80 subjects were enrolled in the study, 39 were randomized to the CWI group and 41 to the TAP group
Summary
Caesarean delivery is one of the most commonly performed surgical procedures and postoperative pain is a great concern for women [1]. Two recent meta-analyses have shown the efficacy of single shot bilateral Transversus Abdominis Plane (TAP) block [5,6] after caesarean section while another demonstrated the usefulness of local anesthetic agent with Continuous Wound Infiltration (CWI) during a few days [7]. The former has been improved by ultrasound guidance [8] and the latter by placement of a multi orifice catheter below the fascia [9]. No prospective trial has directly compared the analgesic efficacy of these two techniques
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