TAP Block for Pain After Cesarean Section

Overseen By Stephen Wood, MD

Age: 18+

Sex: Female

Trial Phase: Academic

Sponsor: University of Calgary

Must not be taking: Local anesthetics, Narcotics

Disqualifiers: Chronic pain, Placenta previa, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 1

Duration: 1 day

80 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a TAP block, a type of pain relief administered during surgery, can reduce pain after a cesarean section. The TAP block involves a special injection in the belly area to decrease the need for pain medication after the procedure. Participants will either receive the TAP block or not, allowing researchers to compare outcomes. Women scheduled for a planned cesarean section with regional anesthesia (numbing from the waist down) and without certain medical conditions may be eligible to join. As an unphased trial, this study provides participants the opportunity to contribute to important research that could enhance post-surgical pain management for future patients.

Will I have to stop taking my current medications?

The trial information does not specify if you need to stop taking your current medications. However, if you have a chronic pain disorder or are dependent on narcotics, you may not be eligible to participate.

What prior data suggests that the TAP block is safe for pain management after a cesarean section?

Research has shown that the Transversus Abdominis Plane (TAP) block is generally safe and well-tolerated. In past studies, patients who received the TAP block experienced less pain and required fewer pain medications after surgery. This method involves injecting a numbing medicine into the abdominal wall and has been used successfully in many surgeries, yielding positive results.

Reports indicate that patients who had a TAP block experienced less pain for 12 to 16 hours after surgery. This suggests that the treatment not only helps with pain but is also safe. Overall, the TAP block is considered a safe option for pain relief after surgeries like cesarean sections. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Transversus Abdominis Plane (TAP) Block for pain relief after a cesarean section because it offers a targeted way to manage post-surgical pain. Unlike standard pain relief methods like oral opioids or epidural analgesia, the TAP block directly delivers a local anesthetic, bupivacaine, to the nerves supplying the abdominal wall. This technique can potentially reduce the need for systemic pain medications, which often come with side effects like nausea or drowsiness. By focusing the pain relief where it’s needed most, the TAP block could enhance recovery and improve overall patient comfort following surgery.

What evidence suggests that a TAP block is effective for pain control after a cesarean section?

Research has shown that a Transversus Abdominis Plane (TAP) block can greatly reduce pain after a cesarean section. In this trial, some participants will receive a TAP block using a 0.25% solution of bupivacaine, which studies have found to effectively lower pain levels. TAP blocks are as effective as other pain relief methods, such as intrathecal morphine (ITM), in managing pain and reducing nausea and vomiting after surgery. Evidence suggests that adding certain medications to the TAP block can further enhance pain relief and patient comfort. Overall, TAP blocks are considered a helpful option for managing pain after cesarean deliveries. ^{2 6 7 8 9}

Who Is on the Research Team?

Stephen Wood, MD

Principal Investigator

University of Calgary

Are You a Good Fit for This Trial?

This trial is for individuals undergoing a cesarean section who are interested in better pain management post-surgery. The study is open to those willing to receive a TAP block, which involves an injection of local anesthetic into the abdominal wall at surgery's end.

Inclusion Criteria

I am having a planned C-section with regional anesthesia at any stage of pregnancy.

ASA status II to III

Exclusion Criteria

I cannot take NSAIDs after giving birth.

I am scheduled for surgery with a vertical cut on my abdomen.

I am scheduled for a Cesarean Hysterectomy.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants undergo a cesarean section with or without a Transversus Abdominis Plane Block (TAP block) administered by the surgeon

1 day

1 visit (in-person)

Post-operative Monitoring

Participants are monitored for pain levels and opioid use post-surgery

48 hours

Follow-up

Participants are monitored for safety and effectiveness after treatment

1-3 days

What Are the Treatments Tested in This Trial?

Interventions

• Transversus Abdominis Plane Block

Trial Overview The study tests if adding a Transversus Abdominis Plane Block with bupivacaine (a long-acting local anesthetic) can improve pain control after cesarean sections, potentially reducing the need for narcotics and shortening hospital stays.

How Is the Trial Designed?

Group I: Surgeon-administered Transversus Abdominis Plane Block (TAP block) Experimental Treatment 1 Intervention

After uterine closure, the anterior abdominal wall on the contralateral side to the surgeon is elevated and retracted laterally by an assistant. The bowel and uterus is retracted using the surgeon's non-dominant hand, with or without a sponge. Under direct visualization, a blunted spinal needle is inserted lateral to the rectus muscle to avoid injury to inferior epigastric blood vessels. The needle is then gently advanced through the transversus abdominis fascia into the TAP plane, identified at loss of resistance, or 'a pop'. After aspiration to confirm no accidental placement of the needle intravascularly, local anaesthetic is infiltrated into the transverse abdominis plane through the parietal peritoneum by the surgeon at a prespecified dose of 0.25% bupivicaine 0.25 mL/kg (approximately 20cc). This is repeated on the contralateral side, after which closure of the fascia, subcutaneous tissue, and skin were performed.

Group II: No TAP block Active Control 1 Intervention

A sham procedure will not be performed but the patient will be unaware of whether or not an injection was done.

Who Is Running the Clinical Trial?

University of Calgary

Lead Sponsor

Trials

827

Recruited

902,000+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6936937/

The efficacy of transversus abdominis plane block for post- ... The USG-TAP block with 0.25% bupivacaine 60 ml (30 ml on each side) significantly reduced post-operative pain in patients undergoing the cesarean section. We ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1089947224001230

Postoperative Cesarean Section Pain Management Using ... Evidence suggests that TAP blocks are equivalent to ITM in pain scores and more effective at lowering the incidence of postoperative nausea and vomiting.

3. clinicaltrials.gov clinicaltrials.gov/study/NCT01170702

Transverse Abdominis Plane (TAP) Block After Cesarean ... The TAP block offers a novel addition to the management of post-cesarean pain for this patient population. Official Title. The Postoperative Analgesic Efficacy ...

4. jopan.org jopan.org/article/S1089-9472(24)00123-0/fulltext

Postoperative Cesarean Section Pain Management Using ... Evidence suggests that TAP blocks are equivalent to ITM in pain scores and more effective at lowering the incidence of postoperative nausea and vomiting.

5. mdpi.com mdpi.com/2077-0383/13/14/4270

Transversus Abdominis Plane Block Following Cesarean ... Conclusions: Adding dexmedetomidine or dexamethasone to bupivacaine in ultrasound-guided TAP blocks reduces postoperative pain and increases patient ...

6. janesthanalgcritcare.biomedcentral.com janesthanalgcritcare.biomedcentral.com/articles/10.1186/s44158-023-00106-6

Bilateral transversus abdominis plane (TAP) block reduces ... The TAP block is an effective and safe locoregional anesthesia technique used in numerous surgical procedures with excellent results [13].

7. sciencedirect.com sciencedirect.com/science/article/pii/S0007091217316288

Review Articles Transversus abdominis plane block for ... TAP block reduced i.v. morphine consumption and pain scores in the first day after surgery. •. TAP block can provide effective analgesia after Caesarean ...

8. imrpress.com imrpress.com/journal/CEOG/51/5/10.31083/j.ceog5105120/htm

The Efficacy of Transversus Abdominis Plane Block for ... Results: Patients who underwent TAP block showed significantly lower pain scores for 12–16 hours after surgery and a reduced total requirement ...

9. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11278202/

Transversus Abdominis Plane Block Following Cesarean ... Background: The transversus abdominis plane (TAP) block is providing effective postoperative analgesia in patients undergoing cesarean section (CS).