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December 18, 2020Open Access

The Analgesic Efficacy of Ultrasound-guided Transversus Abdominis Plane (TAP) Block Combined With Oral Multimodal Analgesia In Comparison With Oral Multimodal Analgesia After Caesarean Delivery: A Randomized Controlled Trial

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Why the study?

TAP blocks are increasingly used after caesarean delivery, but their effectiveness when combined with multimodal oral analgesia required evaluation.

Does ultrasound-guided bilateral single-shot TAP block reduce the need for rescue oxycodone in parturients undergoing elective caesarean delivery on multimodal oral analgesia?

Population

Parturients scheduled for elective caesarean delivery under spinal anaesthesia

Comparison

Bilateral single-shot TAP blocks vs placebo, both added to multimodal oral analgesia

Design

Randomized controlled trial

Follow-up

First 24 hours after surgery

Key result

Bilateral single-shot transversus abdominis plane blocks did not significantly reduce rescue oxycodone requirement compared to placebo (11.4% vs 20.5%, P=0.122) after caesarean delivery.

Authors

YYYang YuSGShenshan GaoVYVivian Manying Yuen

Discussion

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Member takes

Overview

TAP blocks add no benefit atop multimodal oral analgesia post-caesarean; reinforces avoiding routine blocks in this setting.

Study Design

Type

RCT (n=159)

Blinding

Double-blind

Randomization

Block randomization

Multicenter

No

Structured PICO

Does ultrasound-guided bilateral single-shot TAP block reduce the need for rescue oxycodone in parturients undergoing elective caesarean delivery on multimodal oral analgesia?

P
Population
159 parturients undergoing elective caesarean delivery under spinal anesthesia, evaluated for postoperative pain relief over 24 hours.
I
Intervention
Ultrasound-guided bilateral single-shot transversus abdominis plane (TAP) blocks with 15 ml of 0.25% ropivacaine on each side, added to multimodal oral analgesia (tramadol 100mg BID, celecoxib 200mg BID, paracetamol 1000mg QID).
C
Comparator
Placebo (ultrasound scan without injection) added to the same multimodal oral analgesia.
O
Outcome
Percentage of parturients who required oxycodone as rescue analgesia in the first 24 hours after surgery.patient reported

Main Result

Absolute Event Rate: 11.4% vs 20.5%

p-value: p=0.122

Bilateral single-shot TAP blocks do not significantly reduce the need for rescue oxycodone when added to a multimodal oral analgesic regimen after caesarean delivery under spinal anaesthesia.

Limitations

  • Difficult to exclude failed TAP blocks due to residual sensory block from spinal anesthesia

Cite This Study

Yu et al. (2020) conducted an RCT in Postoperative pain after caesarean delivery (n=159). Bilateral single-shot transversus abdominis plane (TAP) block vs. Placebo (ultrasound scan without injection) plus multimodal oral analgesia was evaluated on Percentage of parturients requiring oxycodone as rescue analgesia (p=0.122). Bilateral single-shot transversus abdominis plane blocks did not significantly reduce rescue oxycodone requirement compared to placebo (11.4% vs 20.5%, P=0.122) after caesarean delivery.

synapsesocial.com/papers/6a97887b04c78a31a48bdee4https://doi.org/10.21203/rs.3.rs-50223/v3
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