Comparison of transversus abdominis plane block vs spinal morphine for pain relief after Caesarean section.

Hdl Handle:
http://hdl.handle.net/10147/207727
Title:
Comparison of transversus abdominis plane block vs spinal morphine for pain relief after Caesarean section.
Authors:
McMorrow, R C N; Ni Mhuircheartaigh, R J; Ahmed, K A; Aslani, A; Ng, S-C; Conrick-Martin, I; Dowling, J J; Gaffney, A; Loughrey, J P R; McCaul, C L
Affiliation:
Department of Anesthesia, Rotunda Hospital, Parnell Square, Dublin 1, Ireland.
Citation:
Br J Anaesth. 2011 May;106(5):706-12.
Journal:
British journal of anaesthesia
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207727
DOI:
10.1093/bja/aer061
PubMed ID:
21498494
Abstract:
BACKGROUND: Transversus abdominis plane (TAP) block is an alternative to spinal morphine for analgesia after Caesarean section but there are few data on its comparative efficacy. We compared the analgesic efficacy of the TAP block with and without spinal morphine after Caesarean section in a prospective, randomized, double-blinded placebo-controlled trial. METHODS: Eighty patients were randomized to one of four groups to receive (in addition to spinal anaesthesia) either spinal morphine 100 microg (S(M)) or saline (S(S)) and a postoperative bilateral TAP block with either bupivacaine (T(LA)) 2 mg kg(-1) or saline (T(S)). RESULTS: Pain on movement and early morphine consumption were lowest in groups receiving spinal morphine and was not improved by TAP block. The rank order of median pain scores on movement at 6 h was: S(M)T(LA) (20 mm)<S(M)T(S) (27.5 mm)<S(S)T(S) (51.5 mm)<S(S)T(LA) (52.0 mm) (P<0.05, highest vs lowest). The rank order of median morphine consumption at 6 h was: S(M)T(S) (4.0 mg)<S(M)T(LA) (5.0 mg)<S(S)T(LA) (8.0 mg)<S(S)T(S) (12.0 mg) and at 24 h was: S(M)T(LA) (5.0 mg)<S(M)T(S) (6.0 mg)<S(S)T(S) (9.5 mg)<S(S)T(LA) (15.0 mg) (P<0.05, highest vs lowest). Sedation scores and patient satisfaction did not differ between groups. Anti-emetic use and pruritus were highest in the S(M)T(LA) group. CONCLUSIONS: Spinal morphine-but not TAP block-improved analgesia after Caesarean section. The addition of TAP block with bupivacaine 2 mg kg(-1) to spinal morphine did not further improve analgesia.
Language:
eng
MeSH:
Abdominal Muscles; Adult; Analgesia, Obstetrical/adverse effects/*methods; Analgesics, Opioid/*administration & dosage/adverse effects; Anesthesia, Obstetrical/methods; Anesthesia, Spinal; Antiemetics/administration & dosage; *Cesarean Section; Double-Blind Method; Drug Administration Schedule; Female; Humans; Morphine/*administration & dosage/adverse effects; Nerve Block/adverse effects/*methods; Pain Measurement/methods; Pain, Postoperative/*prevention & control; Patient Satisfaction; Pregnancy; Prospective Studies; Pruritus/chemically induced
ISSN:
1471-6771 (Electronic); 0007-0912 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorMcMorrow, R C Nen_GB
dc.contributor.authorNi Mhuircheartaigh, R Jen_GB
dc.contributor.authorAhmed, K Aen_GB
dc.contributor.authorAslani, Aen_GB
dc.contributor.authorNg, S-Cen_GB
dc.contributor.authorConrick-Martin, Ien_GB
dc.contributor.authorDowling, J Jen_GB
dc.contributor.authorGaffney, Aen_GB
dc.contributor.authorLoughrey, J P Ren_GB
dc.contributor.authorMcCaul, C Len_GB
dc.date.accessioned2012-02-01T10:38:10Z-
dc.date.available2012-02-01T10:38:10Z-
dc.date.issued2012-02-01T10:38:10Z-
dc.identifier.citationBr J Anaesth. 2011 May;106(5):706-12.en_GB
dc.identifier.issn1471-6771 (Electronic)en_GB
dc.identifier.issn0007-0912 (Linking)en_GB
dc.identifier.pmid21498494en_GB
dc.identifier.doi10.1093/bja/aer061en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207727-
dc.description.abstractBACKGROUND: Transversus abdominis plane (TAP) block is an alternative to spinal morphine for analgesia after Caesarean section but there are few data on its comparative efficacy. We compared the analgesic efficacy of the TAP block with and without spinal morphine after Caesarean section in a prospective, randomized, double-blinded placebo-controlled trial. METHODS: Eighty patients were randomized to one of four groups to receive (in addition to spinal anaesthesia) either spinal morphine 100 microg (S(M)) or saline (S(S)) and a postoperative bilateral TAP block with either bupivacaine (T(LA)) 2 mg kg(-1) or saline (T(S)). RESULTS: Pain on movement and early morphine consumption were lowest in groups receiving spinal morphine and was not improved by TAP block. The rank order of median pain scores on movement at 6 h was: S(M)T(LA) (20 mm)<S(M)T(S) (27.5 mm)<S(S)T(S) (51.5 mm)<S(S)T(LA) (52.0 mm) (P<0.05, highest vs lowest). The rank order of median morphine consumption at 6 h was: S(M)T(S) (4.0 mg)<S(M)T(LA) (5.0 mg)<S(S)T(LA) (8.0 mg)<S(S)T(S) (12.0 mg) and at 24 h was: S(M)T(LA) (5.0 mg)<S(M)T(S) (6.0 mg)<S(S)T(S) (9.5 mg)<S(S)T(LA) (15.0 mg) (P<0.05, highest vs lowest). Sedation scores and patient satisfaction did not differ between groups. Anti-emetic use and pruritus were highest in the S(M)T(LA) group. CONCLUSIONS: Spinal morphine-but not TAP block-improved analgesia after Caesarean section. The addition of TAP block with bupivacaine 2 mg kg(-1) to spinal morphine did not further improve analgesia.en_GB
dc.language.isoengen_GB
dc.subject.meshAbdominal Musclesen_GB
dc.subject.meshAdulten_GB
dc.subject.meshAnalgesia, Obstetrical/adverse effects/*methodsen_GB
dc.subject.meshAnalgesics, Opioid/*administration & dosage/adverse effectsen_GB
dc.subject.meshAnesthesia, Obstetrical/methodsen_GB
dc.subject.meshAnesthesia, Spinalen_GB
dc.subject.meshAntiemetics/administration & dosageen_GB
dc.subject.mesh*Cesarean Sectionen_GB
dc.subject.meshDouble-Blind Methoden_GB
dc.subject.meshDrug Administration Scheduleen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshMorphine/*administration & dosage/adverse effectsen_GB
dc.subject.meshNerve Block/adverse effects/*methodsen_GB
dc.subject.meshPain Measurement/methodsen_GB
dc.subject.meshPain, Postoperative/*prevention & controlen_GB
dc.subject.meshPatient Satisfactionen_GB
dc.subject.meshPregnancyen_GB
dc.subject.meshProspective Studiesen_GB
dc.subject.meshPruritus/chemically induceden_GB
dc.titleComparison of transversus abdominis plane block vs spinal morphine for pain relief after Caesarean section.en_GB
dc.contributor.departmentDepartment of Anesthesia, Rotunda Hospital, Parnell Square, Dublin 1, Ireland.en_GB
dc.identifier.journalBritish journal of anaesthesiaen_GB
dc.description.provinceLeinster-
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