Display options
Cite
Habib AS, Nedeljkovic SS, Horn JL, et al. Randomized trial of transversus abdominis plane block with liposomal bupivacaine after cesarean delivery with or without intrathecal morphine. J Clin Anesth. 2021;75:110527doi: 10.1016/j.jclinane.2021.110527.
Habib, A. S., Nedeljkovic, S. S., Horn, J. L., Smiley, R. M., Kett, A. G., Vallejo, M. C., Song, J., Scranton, R., & Bao, X. (2021). Randomized trial of transversus abdominis plane block with liposomal bupivacaine after cesarean delivery with or without intrathecal morphine. Journal of clinical anesthesia, 75110527. https://doi.org/10.1016/j.jclinane.2021.110527
Habib, Ashraf S, et al. "Randomized trial of transversus abdominis plane block with liposomal bupivacaine after cesarean delivery with or without intrathecal morphine." Journal of clinical anesthesia vol. 75 (2021): 110527. doi: https://doi.org/10.1016/j.jclinane.2021.110527
Habib AS, Nedeljkovic SS, Horn JL, Smiley RM, Kett AG, Vallejo MC, Song J, Scranton R, Bao X. Randomized trial of transversus abdominis plane block with liposomal bupivacaine after cesarean delivery with or without intrathecal morphine. J Clin Anesth. 2021 Dec;75:110527. doi: 10.1016/j.jclinane.2021.110527. Epub 2021 Oct 06. PMID: 34626927.
Copy Download .nbib Format: NLM
Share it on

J Clin Anesth. 2021 Dec;75:110527. doi: 10.1016/j.jclinane.2021.110527. Epub 2021 Oct 06.

Randomized trial of transversus abdominis plane block with liposomal bupivacaine after cesarean delivery with or without intrathecal morphine.

Journal of clinical anesthesia

Ashraf S Habib, Srdjan S Nedeljkovic, Jean-Louis Horn, Richard M Smiley, Attila G Kett, Manuel C Vallejo, Jia Song, Richard Scranton, Xiaodong Bao

Affiliations

  1. Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States of America. Electronic address: [email protected].
  2. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
  3. Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America.
  4. Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York City, NY, United States of America.
  5. St. Peter's Healthcare System, Somerset, NJ, United States of America.
  6. West Virginia University, Morgantown, WV, United States of America.
  7. Pacira BioSciences, Inc., Parsippany, NJ, United States of America.
  8. Lyndra Therapeutics, Watertown, MA, United States of America.
  9. Department of Anesthesia, Massachusetts General Hospital, Boston, MA, United States of America.

PMID: 34626927 DOI: 10.1016/j.jclinane.2021.110527

Abstract

STUDY OBJECTIVE: To investigate efficacy and safety of liposomal bupivacaine (LB) transversus abdominis plane (TAP) block with or without intrathecal morphine (ITM) compared with ITM alone for postsurgical analgesia after cesarean delivery (CD).

DESIGN: Multicenter, open-label, randomized trial (NCT03853694).

SETTING: Operating room.

PATIENTS: Women with term pregnancy of 37 to 42 weeks scheduled for elective CD under spinal anesthesia.

INTERVENTION: Patients were randomized 1:1:1 to LB 266 mg TAP block alone (LB group), ITM 50 μg followed by LB 266 mg TAP block (LB + ITM group), or ITM 150 μg alone (ITM group). All groups received the same postsurgical multimodal analgesic regimen.

MEASUREMENTS: The LB and LB + ITM groups were compared with the ITM group for all efficacy outcomes. Postsurgical opioid consumption in morphine milligram equivalents (MMEs) through 72 h was compared by assessing noninferiority before testing superiority. Postsurgical pruritus severity was assessed on an 11-point numerical rating scale.

MAIN RESULTS: Between March 4, 2019, and January 10, 2020, 153 patients (LB, n = 52; LB + ITM, n = 48; ITM, n = 53) were enrolled. Baseline characteristics were comparable across groups. The LB group had statistically noninferior postsurgical opioid consumption through 72 h compared with the ITM group (least squares mean [LSM], 19.2 vs 16.4 MMEs; LSM treatment ratio, 1.17 [95% confidence interval (CI), 0.74-1.86]; noninferiority P < 0.0034) as did the LB + ITM group (LSM, 14.6 vs 16.4 MMEs; LSM treatment ratio, 0.89 [95% CI, 0.55-1.44]; noninferiority P < 0.0001). The LB and LB + ITM groups had significantly reduced pruritus severity scores through 12, 24, 48, and 72 h compared with the ITM group (P ≤ 0.0121). Adverse events occurred in 58%, 85%, and 81% of the LB, LB + ITM, and ITM groups, respectively.

CONCLUSIONS: LB TAP block with or without ITM resulted in statistically noninferior postsurgical opioid consumption through 72 h, reduced pruritus, and favorable safety compared with ITM in women undergoing CD.

Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Keywords: Analgesia, obstetrical; Analgesics, opioid; Anesthesia, obstetrical; Cesarean section; Nerve block; Pruritus

Publication Types