Transversus Abdominis Plane Block May Improve Opioid Use, Pain After Cesarean Section

The use of a transversus abdominis plane block with intrathecal morphine associated with reduced opioid use after cesarean section.

The use of a transversus abdominis plane (TAP) block in conjunction with intrathecal morphine administration may be associated with reduced opioid use in the 24 hours after cesarean section and improvements in pain scores for ≥36 hours, according to a retrospective study published in Regional Anesthesia and Pain Medicine.

In this retrospective review, the data of 142 patients who underwent a cesarean section at the Naval Medical Center in Portsmouth, Virginia, were examined. In this cohort, 43 patients had a TAP block performed for management of postoperative pain. The TAP block consisted of 30 mL of 0.2% ropivacaine injected bilaterally following skin closure.

The time to first opioid use after operating room discharge was the study’s primary outcome, and differences in postoperative pain scores and overall opioid consumption were secondary outcomes.

Patients who received vs did not receive TAP block had a longer time to first opioid use after cesarean section (23.3 hours vs 12.1 hours, respectively; difference, 48.2%; 95% CI, 74.0%-24.3%; P <.001). Patients who received TAP also had lower opioid use within the first 24 hours after surgery compared with those who were not given a TAP block (1.3 mg vs 2.8 mg intravenous morphine equivalents, respectively; difference, 107.1%; 95% CI, 145.1%-69.2%; P =.006).

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Patients in the TAP vs no TAP group also had lower visual analog pain scores 3 hours (1.0 vs 1.9, respectively; P =.003), 6 hours (0.9 vs 1.9, respectively; P =.001), 12 hours (1.4 vs 2.1, respectively; P =.028), 24 hours (2.3 vs 3.8, respectively; P =.001), and 36 hours (3.2 vs 4.1, respectively; P =.019) after surgery.

Study limitations include the small sample size and the retrospective nature of the analysis.

“Other non-opioid pain adjuncts, such as nonsteroidal anti-inflammatory drugs, may be similarly helpful in the post-surgical recovery of this population,” noted the study authors.

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Cole J, Hughey S, Longwell J. Transversus abdominis plane block and intrathecal morphine use in cesarean section: a retrospective review [published online September 13, 2019]. Reg Anesth Pain Med. doi:10.1136/rapm-2019-100483