Article Text

Download PDFPDF
The Transversus Abdominis Plane Block, When Used as Part of a Multimodal Regimen Inclusive of Intrathecal Morphine, Does Not Improve Analgesia After Cesarean Delivery
  1. Joseph F. Costello, MB, FCARCSI,
  2. Albert R. Moore, MD, FRCPC,
  3. Paul M. Wieczorek, MD, FRCPC,
  4. Alison J. Macarthur, MD, FRCPC,
  5. Mrinalini Balki, MBBS, MD and
  6. Jose C.A. Carvalho, MD, PhD, FANZCA, FRCPC
  1. From the Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
  1. Address correspondence to: Jose C.A. Carvalho, MD, PhD, Department of Anesthesia and Pain Management, Mount Sinai Hospital, 600 University Ave, Room 781, Toronto, Ontario, Canada, M5G 1X5 (e-mail: jose.carvalho{at}


Background and Objectives: The transversus abdominis plane (TAP) block has been shown to provide analgesia for lower abdominal wall incisions. We evaluated the efficacy of the TAP block for post-cesarean delivery (CD) patients used as a part of a multimodal regimen.

Methods: Women undergoing elective CD under spinal anesthesia were randomized to receive the TAP block with ropivacaine (n = 50) or placebo (n = 50), in addition to a standard postoperative analgesic regimen inclusive of intrathecal opioids. At the end of the surgical procedure, all the patients received bilateral TAP blocks under real-time ultrasound guidance, with either 20 mL of ropivacaine 0.375% or saline, on each side. Each patient was assessed at 6, 12, 24, and 48 hrs postoperatively, and again 6 weeks after the surgical procedure. The primary outcome was the difference in visual analog scale pain scores with movement at 24 hrs postpartum. Other outcomes assessed were analgesic consumption, maternal satisfaction, and incidence of adverse effects.

Results: One hundred women were recruited, and 96 completed the study. The mean (SD) visual analog scale pain scores on movement at 24 hrs were not different between the ropivacaine and placebo groups (3.4 [2.4] and 3.2 [2.2] cm, respectively, P = 0.47). The pain scores at other times, and the supplemental opioid consumption, were also similar between the 2 groups. The overall incidence of pain at 6 weeks postpartum was 8.3%.

Conclusions: The TAP block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve the quality of post-CD analgesia.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • This study was supported by departmental resources.

  • This study was presented in part at the 40th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology, April 30 to May 4, 2008, Chicago, Ill.