TY - JOUR
T1 - Clinical effectiveness of transversus abdominis plane (TAP) blocks for pain relief after caesarean section
T2 - a meta-analysis
AU - Champaneria, Rita
AU - Shah, Laila
AU - Wilson, MJA
AU - Daniels, Jane
PY - 2016/12
Y1 - 2016/12
N2 - BackgroundThe effectiveness of transversus abdominis plane (TAP) blocks for acute pain relief after caesarean section, in comparison to normal practice, remains uncertain.MethodsElectronic literature databases were searched from inception to May 2016 for randomised controlled trials that assessed the effectiveness of TAP blocks following caesarean section. Trials were eligible if comparisons were made against no block or placebo, and/or intrathecal morphine. Risk of bias was assessed using the Cochrane tool. Data for consistent outcomes were subject, where possible, to meta-analysis and presented as either mean differences with 95% confidence intervals or incidence of a particular event.ResultsTwenty published studies fulfilled our inclusion criteria. TAP blocks significantly reduced pain at rest both when compared with placebo or no TAP blocks (−0.96, 95% CI −1.67 to −0.25, P=0.008) and intrathecal morphine (1.10, 95% CI 0.59 to 1.60, P<0.0001). Both these comparisons showed the greatest improvement with pain on movement, (−1.58, 95% CI −2.69 to −0.47, P=0.005 and 1.35, 95% CI 0.76 to 1.94, respectively,P<0.00001). Morphine consumption was significantly reduced with TAP blocks when compared to placebo or no TAP blocks (−15.88, 95% CI −22.02 to −9.73, P<0.00001). This significance was lost when TAP blocks were both compared to intrathecal morphine (0.89, 95% CI −0.64 to 2.43, P=0.25) and given in co-administration (0.00, 95% CI −0.10 to 0.10, P=1.00).ConclusionTAP blocks provide effective analgesia after caesarean section; however, additional benefits are more difficult to demonstrate when long-acting intrathecal opioids are administered.
AB - BackgroundThe effectiveness of transversus abdominis plane (TAP) blocks for acute pain relief after caesarean section, in comparison to normal practice, remains uncertain.MethodsElectronic literature databases were searched from inception to May 2016 for randomised controlled trials that assessed the effectiveness of TAP blocks following caesarean section. Trials were eligible if comparisons were made against no block or placebo, and/or intrathecal morphine. Risk of bias was assessed using the Cochrane tool. Data for consistent outcomes were subject, where possible, to meta-analysis and presented as either mean differences with 95% confidence intervals or incidence of a particular event.ResultsTwenty published studies fulfilled our inclusion criteria. TAP blocks significantly reduced pain at rest both when compared with placebo or no TAP blocks (−0.96, 95% CI −1.67 to −0.25, P=0.008) and intrathecal morphine (1.10, 95% CI 0.59 to 1.60, P<0.0001). Both these comparisons showed the greatest improvement with pain on movement, (−1.58, 95% CI −2.69 to −0.47, P=0.005 and 1.35, 95% CI 0.76 to 1.94, respectively,P<0.00001). Morphine consumption was significantly reduced with TAP blocks when compared to placebo or no TAP blocks (−15.88, 95% CI −22.02 to −9.73, P<0.00001). This significance was lost when TAP blocks were both compared to intrathecal morphine (0.89, 95% CI −0.64 to 2.43, P=0.25) and given in co-administration (0.00, 95% CI −0.10 to 0.10, P=1.00).ConclusionTAP blocks provide effective analgesia after caesarean section; however, additional benefits are more difficult to demonstrate when long-acting intrathecal opioids are administered.
KW - Transversus abdominis plane block
KW - TAP block
KW - Caesarean section
U2 - 10.1016/j.ijoa.2016.07.009
DO - 10.1016/j.ijoa.2016.07.009
M3 - Article
SN - 0959-289X
VL - 28
SP - 45
EP - 60
JO - International Journal of Obstetric Anesthesia
JF - International Journal of Obstetric Anesthesia
ER -