title: Postoperative analgesia after caesarean section with transversus abdominis plane block or continuous infiltration wound catheter: A randomized clinical trial. TAP vs. infiltration after caesarean section.
abstract: OBJECTIVE
  Single shot transversus abdominis plane (TAP) block and continuous local anesthetic infiltration wound catheter (CLAIWC) decreased the morphine consumption after caesarean section. The aim of this study was to compare the analgesic efficacy of CLAIWC and ultrasound-guided TAP block.
  
  
  METHODS
  Sixty patients undergoing caesarean section were prospectively randomized. After the caesarean section, the postoperative analgesia was randomized to either a CLAIWC localized below the fascia with an elastomeric pump for 48hours or a bilateral ultrasound-guided TAP block with injection of ropivacaine. Every patient had a morphine pump patient-controlled analgesia. The primary outcome was the morphine consumption during the first 48hours. Secondary outcomes were pain score levels, adverse effects of opioids, and patient satisfaction. Variables were collected during 48hours after the caesarean section.
  
  
  RESULTS
  Median cumulative 48-hour morphine consumption was 17 [8-51] mg in the TAP group versus 21 [7-34] mg in the CLAIWC group (P=0.3). We did not find a difference between the groups regarding pain, side effects and satisfaction scores.
  
  
  CONCLUSIONS
  As part of a multimodal analgesic regimen, there is no significant difference between the TAP block and CLAIWC for postoperative analgesia after a caesarean section.
authors.affiliation: Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France; Service de réanimation DRIS, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Klasen
authors.affiliation: Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Bourgoin
authors.affiliation: Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
authors.forename: François
authors.initials: F
authors.lastname: Antonini
authors.affiliation: Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
authors.forename: Emma
authors.initials: E
authors.lastname: Dazeas
authors.affiliation: Service de gynécologie et d'obstétrique, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Bretelle
authors.affiliation: Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Martin
authors.affiliation: Unité d'Aide Méthodologique à la Recherche Clinique et Épidémiologique, Aix Marseille Université, Marseille, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Baumstarck
authors.affiliation: Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France; Centre d'Investigation Clinique 1409, Aix Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille, France. Electronic address: marc.leone@ap-hm.fr.
authors.forename: Marc
authors.initials: M
authors.lastname: Leone
mesh_terms: D000009:Abdominal Muscles; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002404:Catheterization; D002585:Cesarean Section; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine
keywords: Caesarean; Infiltration; Pain; Parturient; TAP