Journal of Pain Research (Dec 2018)
Transversus abdominis plane block with liposomal bupivacaine for pain control after cesarean delivery: a retrospective chart review
Abstract
B Wycke Baker,1–4 Lea G Villadiego,1,2 Y Natasha Lake,1,2 Yazan Amin,3 Audra E Timmins,3 Laurie S Swaim,3 David W Ashton3 1Department of Obstetrical and Gynecological Anesthesiology, Texas Children’s Hospital Pavilion for Women, Houston, TX, USA; 2US Anesthesia Partners, Houston, TX, USA; 3Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA; 4Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA Background: Adverse effects of opioid analgesics and potential for chronic use are limitations in the cesarean setting. Regional anesthesia using transversus abdominis plane (TAP) block post-cesarean delivery may improve analgesia and reduce opioid consumption. Effectiveness of TAP block using liposomal bupivacaine (LB) to reduce post-cesarean pain is unknown.Methods: We performed a single-center retrospective chart review of patients aged ≥18 years who underwent cesarean delivery with a multimodal pain management protocol with or without TAP block with LB 266 mg. Assessments included postsurgical opioid consumption; area under the curve (AUC) of numeric rating scale pain scores from 0 to 3 days; proportion of opioid-free patients; discharge- and post-anesthesia care unit (PACU)-ready time; times to ambulation, solid food, and bowel movement; hospital length of stay (LOS); and adverse events (AEs). Data were analyzed in the total population and in first- and repeat-cesarean subgroups using Wilcoxon, chi-squared, and Student’s t-tests.Results: Of 201 patients, 101 were treated with LB TAP block (LB-TAPB) and 100 without LB-TAPB. Treatment with LB-TAPB vs without LB-TAPB significantly reduced mean postsurgical opioid consumption (total, 47%; first-cesarean, 54%; repeat-cesarean, 42%; P<0.001 each) and mean AUC of pain scores (total, 46%; first-cesarean, 57%; repeat-cesarean, 40%; P<0.001 each). Patients treated with LB-TAPB had significantly shorter mean discharge-ready times (2.9 vs 3.6 days; P=0.006), PACU-ready times (138 vs 163 minutes; P=0.028), and LOS (2.9 vs 3.9 days; P<0.001). LB-TAPB significantly decreased mean times to ambulation and solid food by 39% and 31% (P<0.01 each), respectively, and numerically reduced mean time to bowel movement (26%; P=0.05). Fewer patients treated with LB-TAPB vs without LB-TAPB reported an AE (34% vs 50%; P=0.026).Conclusion: These results suggest multimodal pain management incorporating TAP block with LB 266 mg is an effective approach to reducing opioid requirements and improving analgesia post-cesarean delivery. Keywords: transversus abdominis plane block, liposomal bupivacaine, cesarean section, postoperative pain management
