title: Ultrasound-guided Transversus Abdominis plane block versus continuous wound infusion for post-caesarean analgesia: a randomized trial.
abstract: 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)).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01151943.
authors.affiliation: Department of Anesthesiology, Hôpital Foch, Suresnes, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Chandon
authors.affiliation: Department of Anesthesiology, Institut Hospitalier Franco-Britannique, Levallois-Perret, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Bonnet
authors.affiliation: Department of Anesthesiology, Hôpital Foch, Suresnes, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Burg
authors.affiliation: Department of Anesthesiology, Institut Hospitalier Franco-Britannique, Levallois-Perret, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Barnichon
authors.affiliation: Department of Anesthesiology, Hôpital Foch, Suresnes, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: DesMesnards-Smaja
authors.affiliation: Department of Anesthesiology, Institut Hospitalier Franco-Britannique, Levallois-Perret, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Sitbon
authors.affiliation: Department of Anesthesiology, Hôpital Foch, Suresnes, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Foiret
authors.affiliation: Department of Clinical Research and Innovation, Hôpital Foch, Suresnes, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dreyfus
authors.affiliation: Department of Anesthesiology, Institut Hospitalier Franco-Britannique, Levallois-Perret, France.
authors.forename: Jamil
authors.initials: J
authors.lastname: Rahmani
authors.affiliation: Department of Health Education, Bradford Teaching Hospitals, Leeds, United Kingdom.
authors.forename: Pierre-Antoine
authors.initials: PA
authors.lastname: Laloë
authors.affiliation: Department of Anesthesiology, Hôpital Foch, Suresnes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Fischler
authors.affiliation: Department of Anesthesiology, Hôpital Foch, Suresnes, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Le Guen
mesh_terms: D000009:Abdominal Muscles / Q000000981:diagnostic imaging* / Q000601:surgery*; D000328:Adult; D016362:Analgesia, Obstetrical / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D002585:Cesarean Section / Q000009:adverse effects; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D036502:Infusions, Intralesional; D000077554:Levobupivacaine; D009020:Morphine / Q000008:administration & dosage; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011247:Pregnancy; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D000077554:Levobupivacaine; D002045:Bupivacaine
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