Local anaesthetic techniques for post-caesarean delivery analgesia. (November 2019)

• Record Type: Journal Article
• Authors: Patel, S.D.; Sharawi, N.; Sultan, P.
• Is Part Of: International journal of obstetric anesthesia. Volume 40(2019)
• Page Start: 62
• Page End: 77
• Publication Date: 2019-11
• Subjects: Anaesthetic, local -- Post-caesarean delivery -- Analgesia; Obstetrics -- Periodicals; Anesthesia -- Periodicals; Anesthésie en obstétrique -- Périodiques; Anesthesia; Obstetrics; Electronic journals; Periodicals; 617.9682
• DOI: 10.1016/j.ijoa.2019.06.002
• Languages: English
• ISSNs: 0959-289X

Abstract

Highlights: Transversus abdominis plane (TAP) block may be of benefit for post caesarean pain. TAP block improves analgesia in the absence of intrathecal morphine (ITM). Wound infiltration below the fascia improves analgesia in the absence of ITM. Research should focus on intraperitoneal local anaesthetic. Research should focus on quadratus lumborum and ilio-inguinal/iliohypogastric block. Abstract: In this narrative review we summarise pertinent data from published studies investigating the use of local anaesthetic techniques as adjuncts for managing post-caesarean delivery pain. Based on currently available evidence, ultrasound-guided transversus abdominis plane (TAP), quadratus lumborum (QL) and ilio-inguinal and iliohypogastric (ILIH) blocks are preferable to landmark techniques. When intrathecal morphine is used for caesarean delivery analgesia, TAP blocks do not confer any additional benefit. In the absence of intrathecal morphine, TAP blocks have been shown to reduce pain scores and opioid consumption in the first 24 h postoperatively. In the absence of intrathecal morphine, single-dose local anaesthetic wound infiltration also results in a moderate reduction in opioid consumption postoperatively. If a wound catheter is to be incorporated into a multimodal analgesic regimen, a position below the fascia and a continuous infusion of low-concentration local anaesthetic solutions should be considered. Intraperitoneal local anaesthetic instillation may be of benefit in patients who undergo peritoneal closure but larger studies are still needed. Quadratus lumborum and ILIH blocks show promising results but the data are limited, so recommendations for routine use cannot be made. In summary, evidence supports the use of local anaesthetic techniques for post-caesarean delivery pain but additional research is required to determine the optimum dosing regimens, and the potential role of liposomal local anaesthetics. Further studies are required to compare techniques and determine their role in conjunction with low-dose long-acting neuraxial opioids.