Comparative Study of Two Different Techniques to Perform TAP-blocks
Condition: POSTOPERATIVE PAIN
MeSH terms: Pain, Postoperative
Intervention: Surgical TAP block; Conventional TAP block; 0.5% ropivacaine
Intervention description: surgeon administered TAP block; Anesthesiologist administered TAP block; 20ml of 0.5% ropivacaine is used to perform the TAP block
Intervention MeSH terms: Ropivacaine
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Enrollment: 41.0
Sex: Female
Minimum age: 18 Years
Maximum age: 40 Years
Healthy volunteers: No
Keywords: TAP block, post-cesarean analgesia

Summary:

      The TAP is a space between the muscle layers of the abdominal wall that houses nerves
      supplying the abdominal skin. Injecting the local anesthetic ropivacaine into this space will
      block these nerves and prevent pain following c-section. The investigators will compare two
      different approaches to injecting the local anesthetic in this space. Conventionally, the
      block is done after surgery is completed and the abdomen is closed. The anesthesiologist
      introduces a needle through the abdominal wall skin under ultrasound guidance to reach the
      TAP space and the drug is injected. Since the TAP layer is one of the deeper layers of the
      abdominal (belly) wall and is closer to the inside of the abdomen than to the outside (skin),
      injecting from the inner aspect of the abdominal wall during the surgery is easier and
      quicker to perform than the conventional block and does not require ultrasound guidance as
      there is no risk of injury to abdominal organs like the liver.

      With this research the investigators attempt to prove that surgically administered TAP blocks
      take 25% less time to perform compared to the conventionally administered TAP block for post
      cesarean section pain relief. Surgical TAP blocks are also more cost-effective as in addition
      to reduced OR time, they are safer and do not require skilled operator and specialized
      equipment. Secondary outcomes will include total time spent in the Operating room, presence
      and severity of postoperative pain, time to first request for pain medication, total
      postoperative narcotic consumption in 48 hours after surgery and side effects.
    

Eligibility criteria:

        Inclusion Criteria:

          -  We will recruit women undergoing scheduled cesarean delivery under neuraxial
             anesthesia

        Exclusion Criteria:

          -  Age less than 18 years

          -  We will limit recruitment to women able to speak atleast one of the following
             languages: English, Spanish, Chinese, Russian

          -  Chronic pain syndrome

          -  Opioid dependence

          -  Allergy to local anesthetic

          -  Vertical skin incision

          -  Sepsis at the site of injection

          -  Converted to general anesthesia

          -  Any complicated procedures including blood loss more than 2000ml and duration of
             surgery more than 2 hours.