title: Subarachnoid morphine versus TAP blocks for enhanced recovery after caesarean section delivery: A randomized controlled trial.
abstract: BACKGROUND
  Subarachnoid morphine is widely used for pain relief in enhanced recovery program after cesarean section in spite of its side effects. However, the role of TAP block is still controversial. The aim of our study was to compare the impact of these analgesic techniques (subarachnoid morphine and TAP block) on enhanced recovery after cesarean section.
  
  
  METHODS
  In this randomized controlled trial, we included patients scheduled for cesarean delivery under spinal anesthesia. Patients were randomized in two groups. Group I: received spinal anesthesia with 100μg of subarachnoid morphine. Group II: received spinal anesthesia without subarachnoid morphine followed by an ultrasound-guided TAP block. We assessed the time required for mobilization, for re-establishment of gastrointestinal transit and for breast-feeding.
  
  
  RESULTS
  TAP block allowed earlier postoperative mobilization. Time required for getting up was significantly lower in group II (9.4h versus 6.9h; P=0.024) as well as time required for walking (12.4h versus 7.4h; P=0.001). TAP block allowed earlier re-establishment of gastrointestinal transit (11.2h in group I versus 8.1h in group II; P<0.001).
  
  
  CONCLUSIONS
  TAP block seems to be suitable with enhanced recovery programs.
authors.affiliation: Anaesthesiology department, Hedi Chaker university hospital, Sfax, Tunisia. Electronic address: anouar_jarraya@hotmail.com.
authors.forename: Anouar
authors.initials: A
authors.lastname: Jarraya
authors.affiliation: Anaesthesiology department, Hedi Chaker university hospital, Sfax, Tunisia.
authors.forename: Jamil
authors.initials: J
authors.lastname: Zghal
authors.affiliation: Anaesthesiology department, Hedi Chaker university hospital, Sfax, Tunisia.
authors.forename: Sofiene
authors.initials: S
authors.lastname: Abidi
authors.affiliation: Anaesthesiology department, Hedi Chaker university hospital, Sfax, Tunisia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Smaoui
authors.affiliation: Anaesthesiology department, Hedi Chaker university hospital, Sfax, Tunisia.
authors.forename: Kamel
authors.initials: K
authors.lastname: Kolsi
mesh_terms: D000009:Abdominal Muscles / Q000000981:diagnostic imaging; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D000762:Anesthesia Recovery Period; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D002585:Cesarean Section / Q000379:methods*; D004434:Early Ambulation; D005260:Female; D006801:Humans; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use*; D009407:Nerve Block / Q000009:adverse effects; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D011247:Pregnancy; D018084:Ultrasonography, Interventional; D016138:Walking
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Cesarean section; Enhanced recovery; Subarachnoid morphine; TAP block