Anesthésie et recherche clinique
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A Randomized Controlled Trial Comparing the Efficacy of the Transversus Abdominus Plane Block with Two Concentrations of Bupivacaine in Patients Undergoing Cesarean Delivery

Balasubramaniam P, Farthing J, Weinberg J, Yarmush J and Schianodicola J

Background: To investigate whether Transversus Abdominis Plane (TAP) block using either 0.5% or 0.25% bupivacaine confers additional analgesia for Cesarean section patients when compared to placebo.

Methods: 60 parturients undergoing elective Cesarean delivery under combined spinal epidural anesthesia were enrolled and randomized into 3 groups. Bilateral TAP block was performed postoperatively using 15 ml solution on each side. Arm 1 received 0.5% bupivacaine, arm 2 received 0.25% bupivacaine and arm 3 received normal saline. All patients received epidural morphine after the umbilical cord was clamped. Pain and other parameters were assessed at 0 h, 3 h, 6 h, 24 h, and 48 h postoperatively. The primary outcome is the number of PCA boluses used by the patients postoperatively within 24 h. Appropriate statistical tests were used.

Results: The pain scores at 3 h, 6 h, 24 h, and 48 h were significantly lower in both bupivacaine groups compared to the placebo group (p-value between 0.0281-0.0066). Fewer PCA boluses (p-value between 0.0245-0.0011) and higher satisfaction (p-values between 0.0092-0.0009) were found in both bupivacaine groups compared to the placebo group. No significant difference was noted between bupivacaine groups. No significant differences were noted in secondary objectives among the three groups.

Conclusion: 0.5% and 0.25% bupivacaine TAP blocks were associated with reduced pain scores, decreased PCA requirements, and greater satisfaction than placebo. We conclude that 0.25% bupivacaine is ideal for use in TAP block as a part of multimodal analgesic regimen that includes neuraxial morphine in cesarean section patients.