Transversus abdominis plane block compared with wound infiltration for postoperative analgesia following Cesarean delive
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Transversus abdominis plane block compared with wound infiltration for postoperative analgesia following Cesarean delivery: a systematic review and network meta-analysis Comparaison d’un bloc du plan du muscle transverse de l’abdomen a` une infiltration de l’incision chirurgicale pour l’analge´sie postope´ratoire suivant un accouchement par ce´sarienne: une revue syste´matique et me´ta-analyse en re´seau . Selina D. Patel, BMBS, FRCA . Pervez Sultan, MBChB, FRCA, MD (Res) . Sandra Jadin, MD Brendan Carvalho, MBBCh, FRCA . Stephen H. Halpern, MD, MSc, FRCPC Received: 25 February 2020 / Revised: 2 July 2020 / Accepted: 29 July 2020 Ó Canadian Anesthesiologists’ Society 2020
Abstract Purpose This systematic review and network metaanalysis (NMA) compared postoperative analgesic Presented in part at the Society for Obstetric Anesthesiology and Perinatology meeting, Miami, USA in 2018 and Obstetric Anaesthesia Association meeting, Belfast, UK in 2018. This article is accompanied by an editorial. Please see Can J Anesth 2020; this issue.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-020-01818-x) contains supplementary material, which is available to authorized users. P. Sultan, MBChB, FRCA, MD (Res) (&) Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA e-mail: [email protected] Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA S. D. Patel, BMBS, FRCA Department of Anesthesia, Pain and Perioperative Medicine, University of Miami Miller School of Medicine, Miami, FL, USA S. Jadin, MD S. H. Halpern, MD, MSc, FRCPC Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada B. Carvalho, MBBCh, FRCA Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
efficacy of transversus abdominis plane (TAP) blocks with that of wound infiltration for Cesarean delivery (CD) without long-acting neuraxial opioid administration. Methods We sought randomized-controlled trials comparing TAP vs wound infiltration, and inactive control vs either TAP or wound infiltration. Wound infiltration included single-dose infiltration (WI), or continuous infusion via a catheter (WC). The primary outcome was 24 hr opioid consumption. Secondary outcomes included 12 and 24 hr pain scores (resting and movement), time to first analgesia request, incidence of postoperative nausea and vomiting (PONV), maternal sedation, and pruritus. We performed a NMA incorporating both direct and indirect comparisons and reported standardized mean differences and odds ratios with 95% confidence intervals for continuous and dichotomous outcomes. Results Forty-two studies were included, comprising 2,906 participants. Transversus abdominis plane blocks and WC were associated with significantly lower 24 hr opioid consumption than inactive controls, but there were no significant differences between WI and inactive con
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