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LETTER TO THE EDITOR

Transversus Abdominis Plane Block in a Patient with Debilitating Pain from an Abdominal Wall Hematoma Following Cesarean Delivery

Department of Anesthesia and Pain Management; Mount Sinai Hospital; University of Toronto; Ontario, Canada; joeycos{at}eircom.net

To the Editor:

Two recently published trials have shown that the transversus abdominis plane (TAP) block reduces postoperative opioid requirements in patients who have undergone laparotomies.1,2 Recently, we successfully performed this technique on a patient with severe, debilitating pain 48 h after a cesarean delivery under spinal anesthesia. The postoperative pain management regimen included intrathecal opioids, standing orders of acetaminophen and diclofenac, and opioids for breakthrough pain. Approximately 36 h after the procedure, the patient developed a large hematoma on her anterior abdominal wall (14.5 cm x 5 cm x 4 cm on abdominal CT scan), resulting in severe pain interfering with breastfeeding and ambulation. The surgical decision was to manage the hematoma conservatively. Her VAS score was 10/10, and pain relief was not obtained from 15 mg of oral morphine and 15 mg of IV morphine. Complete pain relief was obtained 30 min after bilateral TAP block using 40 mL of 0.25% bupivacaine. The patient stated that she was "now able to dance." She reported no pain on rest or on movement for 18 h, and only received 5 mg oral morphine 24 h later. This previously unreported use of the TAP block in a patient with significant postoperative pain adds to the growing body of evidence supporting the use of the TAP block in clinical practice.

REFERENCES

1. McDonnell JG, Curley G, Carney J, Benton A, Costello J, Maharaj CH, Laffey JG. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg 2008;106:186–91[Abstract/Free Full Text]
2. McDonnell JG, O’Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg 2007;104:193–97[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Randall, I. M. Articles by Carvalho, J. C. A. Search for Related Content PubMed PubMed Citation Articles by Randall, I. M. Articles by Carvalho, J. C. A.