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In the Literature: New Research from Our Faculty (Drs. Indu Singh, Shalani Dhir and Kristine Marmai)

Friday, May 10, 2013

Int J Obstet Anesth. 2013 May 3. [Epub ahead of print].

Efficacy of ultrasound-guided transversus abdominis plane blocks for post-cesareandelivery analgesia: a double-blind, dose-comparison, placebo-controlled randomized trial.

Singh SDhir SMarmai K, Rehou S, Silva M, Bradbury C. 


Singh S et al. – The authors compared the analgesic efficacy of two doses of local anesthetic for TAP (transversus abdominis plane) blocks after cesarean delivery. Neither high– or low–dose TAP blocks as part of a multimodal analgesia regimen including intrathecal morphine improved pain scores with movement at 24h after cesarean delivery when compared to placebo TAP blocks. High–dose TAP blocks may improve pain scores up to 12h after cesarean delivery.


  • Sixty women having cesarean delivery under spinal anesthesia were randomized to receive ultrasound–guided TAP blocks using either high–dose ropivacaine (3mg/kg), low–dose ropivacaine (1.5mg/kg) or placebo.

  • Patients received intrathecal 0.75% bupivacaine 10–12mg, fentanyl 10µg and morphine 150µg and standard multimodal analgesia.

  • The primary outcome was the difference in pain with movement using a numeric rating scale at 24h.

  • Other outcomes included time to first request for analgesia, pain scores at 6, 12, 36, 48h and at 6 and 12weeks, opioid consumption, adverse effects, quality of recovery, and satisfaction.


  • There were no differences between groups in the primary outcome.

  • Mean±SD pain scores (0–10) with movement at 24h were: high–dose ropivacaine 3.6±1.5, low–dose ropivacaine 4.6±2.1 and placebo 4.1±1.7.

  • With respect to secondary outcomes, the mean±SD pain scores at 6h were lower in the high–dose group 2.0±1.8 compared to the low–dose 3.4±2.7 and placebo groups 4.2±2.0 (P=0.009).

  • Pain scores at 12h were also lower in the high–dose group 2.2±2.0 compared to the low–dose group 4.1±2.7 and placebo group 4.0±1.3 (P=0.011).

  • There was no difference in other outcomes between groups.


To view the article online, visit MDLinx's feature page

Congratulations to Dr. Indu Singh and co-authors, for having their article: Efficacy of ultrasound-guided transversus abdominis plane blocks for post-cesarean delivery analgesia: a double-blind, dose-comparison, placebo-controlled randomized trial, recognized for excellence in the field of anesthesiology by