• Anaesthesia · Feb 2019

    Randomized Controlled Trial Comparative Study

    The analgesic effects of intrathecal morphine in comparison with ultrasound-guided transversus abdominis plane block after caesarean section: a randomised controlled trial at a Ugandan regional referral hospital.

    What did they do?

    The researchers randomised 130 women to 10 mg intrathecal hyperbaric bupivacaine plus an ultrasound-guided TAP block, or to 10mg intrathecal hyperbaric bupivacaine with 100 mcg morphine, plus a sham TAP block.

    And they found

    There was no difference between either group for satisfaction, analgesia or adverse effects. They concluded that in the context of intrathecal morphine availability, there is no benefit from TAP block, although TAP block can produce comparable analgesia if IT morphine is not used.

    What’s particularly interesting...

    Unlike the majority of obstetric anaesthesia research, this study comes from the same environment that also manages the bulk of global deliveries: low and medium income countries.

    It is also an important reminder that not only are techniques used in wealthier countries applicable and translatable to lower-resource settings, but so is high quality research – and as with all research, context is everything.

    summary
    • A Kwikiriza, J K Kiwanuka, P G Firth, M A Hoeft, V E Modest, and S S Ttendo.
    • Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda.
    • Anaesthesia. 2019 Feb 1; 74 (2): 167-173.

    AbstractBoth transversus abdominis plane block and intrathecal morphine may produce prolonged postoperative analgesia, but the respective clinical outcomes of these anaesthetic techniques in resource-limited settings are not well described. We randomly assigned patients undergoing caesarean section to receive a hyperbaric bupivacaine (10 mg) spinal anaesthetic followed by an ultrasound-guided transversus abdominis plane block, or a hyperbaric bupivacaine (10 mg) spinal anaesthetic with 100 mcg intrathecal morphine, followed by a postoperative sham block. Supplemental postoperative analgesia included self-administered oral diclofenac 50 mg and paracetamol 1 g every 8 h. Numerical pain rating scores, the need for rescue medication, side-effects and patient satisfaction were recorded at 8, 16 and 24 h. We enrolled a total of 130 patients, with 65 women in each group. The mean numerical rating score for intrathecal morphine vs. transversus abdominis plane blocks at 8 h were: at rest, 2.5 vs. 3.1 (p = 0.04); with coughing, 4.3 vs. 4.8 (p = 0.07); and with movement, 3.6 vs. 4.2 (p = 0.06). At 16 h, respective scores were: 2.9 vs. 3.1 (p = 0.40) at rest; 4.0 vs. 4.3 (p = 0.19) with coughing; and 4.8 vs. 5.0 (p = 0.33) with movement. At 24 h, the respective scores were: 2.9 vs. 2.3 (p = 0.01); 4.6 vs. 4.2 (p = 0.04) with coughing; and 3.9 vs. 3.4 (p = 0.02) with movement. The need for rescue medication and the incidence of pruritis, sedation and nausea and vomiting were similar in both groups. Patient satisfaction with pain control was similar in both groups, with the majority of patients reporting satisfaction as good or excellent. Intrathecal morphine and transversus abdominis plane block provided clinically similar outcomes for pain relief after caesarean section.© 2018 Association of Anaesthetists.

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    This article appears in the collection: How effective is the Transversus Abdominis Plane (TAP) Block?.

    Notes

    summary
    1

    What did they do?

    The researchers randomised 130 women to 10 mg intrathecal hyperbaric bupivacaine plus an ultrasound-guided TAP block, or to 10mg intrathecal hyperbaric bupivacaine with 100 mcg morphine, plus a sham TAP block.

    And they found

    There was no difference between either group for satisfaction, analgesia or adverse effects. They concluded that in the context of intrathecal morphine availability, there is no benefit from TAP block, although TAP block can produce comparable analgesia if IT morphine is not used.

    What’s particularly interesting...

    Unlike the majority of obstetric anaesthesia research, this study comes from the same environment that also manages the bulk of global deliveries: low and medium income countries.

    It is also an important reminder that not only are techniques used in wealthier countries applicable and translatable to lower-resource settings, but so is high quality research – and as with all research, context is everything.

    Daniel Jolley  Daniel Jolley
     
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