Intraoperative TAP Block After Repeat Cesarean
- Conditions
- Post-operative Pain
- Interventions
- Procedure: TAP Block Group
- Registration Number
- NCT05393908
- Lead Sponsor
- University of Massachusetts, Worcester
- Brief Summary
The aim of this study is to perform a randomized trial to investigate if intraoperative surgeon administered TAP block reduces pain and use of oral and parenteral pain medications after repeat cesarean delivery. The investigators aim to compare surgeon administered TAP block with liposomal bupivacaine compared to standard treatment (i.e. no TAP block) with regard to the primary outcome of post-operative narcotic use.
- Detailed Description
Transversus abdominis plane (TAP) block is a well-described technique to provide a field block for analgesia. It has been shown to be effective in postoperative analgesia after cesarean delivery. TAP blocks are commonly performed post-operatively by anesthesiologists using liposomal bupivacaine with ultrasound guidance. Liposomal bupivacaine is an FDA approved medication for post-surgical analgesia and available at UMass-Memorial Medical Center. Liposomal bupivacaine provides sustained release of medication for up to 120 hours. A recent multicenter randomized controlled trial demonstrated the efficacy of anesthesiologist administered TAP blocks using liposomal bupivacaine after cesarean delivery. Infiltration of the skin and fascia with liposomal bupivacaine after cesarean did not have an effect and this can be explained by the path that the pain fibers take through the TAP which makes them amenable to a TAP block while a superficial infiltration is ineffective.The aim of this study is to perform a randomized trial to investigate if intraoperative surgeon administered TAP block reduces pain and use of oral and parenteral pain medications after repeat cesarean delivery. The investigators aim to compare surgeon administered TAP block with liposomal bupivacaine compared to standard treatment (i.e. no TAP block) with regard to the primary outcome of post-operative narcotic use.
Recruitment & Eligibility
- Status
- WITHDRAWN
- Sex
- Female
- Target Recruitment
- 40
- Pregnant women presenting for elective repeat cesarean delivery at 37-42 weeks gestational age.
- Pregnancy and delivery care obtained at UMass Memorial Medical Center
- Patients able to provide written informed consent
- English, Spanish, or Portuguese-speaking patients
- Participants who are under the age of 18 years
- Active labor.
- Baseline pain score > 6.
- Unable to provide informed consent.
- Prisoners will be excluded from this research.
- Narcotic use in the 2 weeks prior to delivery.
- Active substance abuse.
- Inability to take narcotic analgesia.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description TAP Block Group TAP Block Group Participants will receive a surgeon administered TAP block consisting of liposomal bupivacaine during their repeat cesarean delivery.
- Primary Outcome Measures
Name Time Method Daily Narcotic Use in Morphine Equivalents From time of surgery through postpartum day 4 Daily Narcotic Use in Morphine Equivalents
- Secondary Outcome Measures
Name Time Method Time to first administered narcotic (oral or parental) From time of surgery through postpartum day 4 Time to first administered narcotic (oral or parental) post cesarean delivery
Daily Maximum Pain Score From time of surgery through postpartum day 4 Daily Average Pain Score based on ten point pain scale (minimum 0, maximum 10) with higher numbers indicating worse pain
Daily Average Pain Score From time of surgery through postpartum day 4 Daily Average Pain Score based on ten point pain scale (minimum 0, maximum 10) with higher numbers indicating worse pain
Time to First Ambulation From time of surgery through postpartum day 4 Time to First Ambulation post cesarean delivery
Time to First Solid Food From time of surgery through postpartum day 4 Time to First Solid Food