Ultrasound-Guided Transversus Abdominis Plane Block versus Continuous Wound Infusion for Post-Caesarean Analgesia: A Randomized TrialReportar como inadecuado




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Objective

To compare the analgesic effect of ultrasound-guided Transversus Abdominis Plane TAP block versus Continuous Wound Infusion CWI with levobupivacaine after caesarean delivery.

Methods

We 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.

Results

Recruitment 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.

Conclusion

In 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 Registration

ClinicalTrials.gov NCT01151943



Autor: Michel Chandon, Agnès Bonnet, Yannick Burg, Carole Barnichon, Véronique DesMesnards-Smaja, Brigitte Sitbon, Christine Foiret, J

Fuente: http://plos.srce.hr/



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