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August 31, 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?

The TAP block is increasingly used after caesarean delivery, but its effectiveness in patients receiving multimodal oral analgesia required evaluation.

Does ultrasound-guided TAP block reduce the requirement for oxycodone rescue analgesia in parturients receiving multimodal oral analgesia after elective caesarean delivery?

Comparison

TAP block vs placebo in addition to multimodal oral analgesia

Design

Randomized controlled trial

Follow-up

First 24 hours after surgery

Key result

Ultrasound-guided transversus abdominis plane block did not significantly reduce the requirement for rescue oxycodone compared to placebo (11.4% vs 20.5%, p=0.122) in parturients receiving multimodal oral analgesia after caesarean delivery.

Authors

YYYang YuSGShenshan GaoVYVivian Manying Yuen

Discussion

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Overview

TAP block adds no meaningful benefit to multimodal oral analgesia after cesarean; challenges routine addition and supports oral regimens alone in trials.

Study Design

Type

RCT (n=159)

Blinding

Double-blind

Randomization

Block randomization

Multicenter

No

Structured PICO

Does ultrasound-guided TAP block reduce the requirement for oxycodone rescue analgesia in parturients receiving multimodal oral analgesia after elective caesarean delivery?

P
Population
159 parturients with ASA physical status I or II undergoing elective caesarean delivery under spinal anaesthesia, evaluated for postoperative pain and analgesic requirements over 24 hours.
I
Intervention
Ultrasound-guided transversus abdominis plane (TAP) block (15 ml of 0.25% ropivacaine on each side) added to multimodal oral analgesia (tramadol 100 mg twice daily for 2 days, celecoxib 200 mg twice daily for 3 days, paracetamol 1000 mg four times daily for 4 days).
C
Comparator
Placebo (ultrasound scan performed but no TAP block injection) added to the same multimodal oral analgesia.
O
Outcome
Percentage of parturients who required oxycodone rescue analgesia in the first 24 hours.patient reported

Main Result

Absolute Event Rate: 11.4% vs 20.5%

p-value: p=0.122

Ultrasound-guided TAP block provides no significant additional reduction in rescue analgesic requirements when combined with a multimodal oral analgesic regimen after caesarean delivery.

Limitations

  • Intrathecal morphine, considered the best option for post-caesarean pain relief, was not available or used in this center.
  • Single-center study design.

Cite This Study

Yu et al. (2020) conducted an RCT in Postoperative pain after caesarean delivery (n=159). Ultrasound-guided Transversus Abdominis Plane (TAP) block vs. Placebo (sham block) plus multimodal oral analgesia was evaluated on Percentage of parturients who required oxycodone rescue analgesia for breakthrough pain in the first 24 hours (p=0.122). Ultrasound-guided transversus abdominis plane block did not significantly reduce the requirement for rescue oxycodone compared to placebo (11.4% vs 20.5%, p=0.122) in parturients receiving multimodal oral analgesia after caesarean delivery.

synapsesocial.com/papers/6a97887b04c78a31a48bdee6https://doi.org/10.21203/rs.3.rs-50223/v1
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