TAP Block Using Liposomal Bupivacaine for Post-cesarean Delivery Analgesia- Walking Towards Recovery
Status:
Recruiting
Trial end date:
2022-08-30
Target enrollment:
Participant gender:
Summary
The TAP block offers analgesia by blocking the sensory nerves of the anterior abdominal wall.
The procedure is performed under ultrasound guidance, after identification of the external
oblique, internal oblique and transverse abdominis muscle. Medication is injected in the
neurofascial plane between the internal oblique and the tranversus abdominis muscle.
Previous studies have demonstrated limited (<24 hour) effect of the block when compared to
the use of intrathecal morphine (considered to be the "gold standard" for postoperative
analgesia). In a study by McMarrow et al., post-caesarian pain control combinations including
TAP blocks with local anesthetic (Bupivacaine) or saline after a spinal anesthetic with or
without intrathecal morphine were compared.
At 6 hours the Morphine consumption was slightly reduced in the patients that received both
intrathecal morphine and TAP blocks with LA when compared to patients that received spinal
saline and TAP with saline. At 24 hours the TAP block conferred no benefit in terms of opioid
consumption. Similarly, the study by Lee et al. demonstrated better pain scores for the first
2 hours in patients receiving both intrathecal morphine and a TAP block with ropivacaine. At
24 hours there was no difference in the pain scores for patients that received both
intrathecal morphine and TAP blocks.
On the contrary, a more recent study utilizing liposomal bupivacaine has been utilized for
TAP blocks for post cesarean delivery analgesia, demonstrating opioid reductions for up to 72
hours. Liposomal bupivacaine is a novel, multivesicular formulation designed for rapid
absorption, prolonged release of bupivacaine, and analgesia following a single
intra-operative administration into the surgical wound or for TAP blocks.
Current anesthesia practices encourage the use of multimodal analgesia that aim at enhanced
recovery after surgery (ERAS). The ERAS model aims to decrease immobility, pain and
post-operative ileus. Pain and immobility may be closely related, and the latter has rarely
been monitored in the post-operative setting. It is planned to use a research validated
fit-bit like device (Actigraph GT3-X) to monitor patient steps (mobility).