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Transversus abdominis plane block and intrathecal morphine use in cesarean section: a retrospective review
  1. Jacob Cole,
  2. Scott Hughey and
  3. Jason Longwell
  1. Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
  1. Correspondence to Dr Jacob Cole, Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA; cole.jacob.h{at}


Objectives Cesarean delivery is an extremely common surgical procedure practiced worldwide. It is an open abdominal surgery, and is associated with significant postoperative pain. One modality that helps alleviate this pain is the transversus abdominis plane (TAP) block. This analysis sought to evaluate postoperative pain when this block was used in conjunction with intrathecal morphine.

Methods A retrospective review was performed of 142 patients who underwent cesarean section at our institution. Of those, 43 patients had a TAP block performed. The primary outcome for this analysis was the time to first opioid administration following discharge from the operating room. Secondary outcomes included differences in postoperative pain scores, and overall opioid consumption.

Results The average time to first opioid use postoperatively decreased in the TAP group when compared with the No-TAP group, 23.3 versus 12.1, respectively (difference of 48.2% (95% CI 74.0% to 24.3%); p<0.001) and opioid consumption was significantly decreased within the first 24 hours following surgery from 4.55 intravenous morphine equivalents (IVME) to 2.67 IVME, respectively (difference of 107.1% (95% CI 145.1% to 69.2%); p=0.006). Visual analog pain scores were significantly decreased in the TAP group versus the No-TAP group up to 36 hours postoperatively.

Conclusions TAP blocks performed in conjunction with intrathecal morphine may decrease opioid use in the first 24 hours and improve pain scores for at least 36 hours following cesarean section. Because of the favorable safety profile, TAP blocks may contribute meaningfully to multimodal anesthesia for cesarean sections.

  • Anesthesia, Obstetrical/therapy
  • adjuvants, anesthesia/therapy
  • nerve block/methods

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  • JC and SH contributed equally.

  • Contributors SH, JC, and JL contributed to the design and implementation of the research, as well as to the writing of the manuscript. SH and JC performed the data collection and data analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed in this manuscript reflect the results of research conducted by the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. We are military service members. This work was prepared as part of our official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Research data derived from an approved Naval Medical Center, Portsmouth, Virginia IRB, protocol; number NMCP.2018.0059.

  • Provenance and peer review Not commissioned; externally peer reviewed.