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Background and Aims Cesarean surgical deliveries account for 31.8% of deliveries worldwide and 38 million projected by 2030. To reduce pain and suffering due to visceral and somatic pain, several multimodal ERAS protocols including various plane type blocks have been developed and utilized to promote recovery and minimize opioids. This study aimed to compare ERAS protocols utilizing either an Anterior Cul de Sac catheter or TAP block to further decrease opioid requirements from a well-established 10-year protocol requiring a mean morphine consumption of 1.7 mg during POD-0.
Methods A retrospective chart analysis of 81 cesarean patients that received a standard ERAS protocol including spinal anesthesia with 0.1mg of morphine and NSAIDS. Group 1 received single injection bilateral TAP blocks with 15 mL 0.5% ropivacaine. Group 2 received ACDS catheter with 15 mL bolus 0.5% ropivacaine followed by 10 mL/hr 0.2% ropivacaine infusion for 54.5 hours. The primary outcome measured was opioid consumption during postoperative day (POD) 0 through 3.
Results Subjects that received ACDS catheters consumed significantly less opioids as measured in morphine equivalents (mg) in comparison to the bilateral TAP block patients on POD 0 (average of 0.39 mg versus 1.68 mg respectively; p=0.034) and POD 1 (average of 2.21 mg versus 4.87 respectively; p=0.034). Total opioid consumption for the entire hospital stay was significantly less in the ACDS group in comparison to the TAP group (average of 3.4 mg versus 8.1 mg respectively; p=0.024).
Conclusions The ACDS catheters reduce opioid requirements compared to the TAP blocks with longer analgesia without increasing pain scores.