Subarachnoid morphine versus TAP blocks for enhanced recovery after caesarean section delivery: A randomized controlled trial

Introduction: Subarachnoid morphine is widely used for pain relief in enhanced recovery program after cesarean section in spite of its side effects. However, the role of TAP block is still controversial. The aim of our study was to compare the impact of these analgesic techniques (subarachnoid morphine and TAP block) on enhanced recovery after cesarean section. Materials and methods: In this randomized controlled trial, we included patients scheduled for cesarean delivery under spinal anesthesia. Patients were randomized in two groups. Group I: received spinal anesthesia with 100 mg of subarachnoid morphine. Group II: received spinal anesthesia without subarachnoid morphine followed by an ultrasound-guided TAP block. We assessed the time required for mobilization, for re-establishment of gastrointestinal transit and for breast-feeding. Results: TAP block allowed earlier postoperative mobilization. Time required for getting up was significantly lower in group II (9.4 h versus 6.9 h; P = 0.024) as well as time required for walking (12.4 h versus 7.4 h; P = 0.001). TAP block allowed earlier re-establishment of gastrointestinal transit (11.2 h in group I versus 8.1 h in group II; P < 0.001). Conclusions: TAP block seems to be suitable with enhanced recovery programs. (C) 2016 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.