PainRelief.com Interview with:
B. Wycke Baker, MD
Chief of Service, Anesthesiology at Texas Children’s Pavilion for Women
Clinical Professor of Anesthesiology, Obstetrics and Gynecology
Baylor College of Medicine
PainRelief.com: What is the background for this study? What are the main findings?
Response: For this study, we reviewed the charts of 201 women who underwent cesarean deliveries and received a multimodal pain management protocol with or without a TAP block utilizing EXPAREL, a long-acting, non-opioid option to manage pain following surgery. A TAP block, or a transversus abdominis plane block, is a field block that numbs the nerves that supply the abdominal wall. The study included patients who underwent elective, unscheduled waiting list, or emergency cesarean delivery with combined spinal-epidural anesthesia and post-cesarean pain management at Texas Children’s Hospital Pavilion for Women between 2012 and 2015.
The findings revealed many positive outcomes for patients who received a TAP block utilizing EXPAREL compared to those who received multimodal pain control without a TAP block utilizing EXPAREL. For instance, patients who received EXPAREL TAP block showed a significant decrease in postsurgical pain as well as a significant decrease in opioid consumption. On average, patients who received EXPAREL TAP block had shorter time to discharge from PACU, shorter time to readiness for discharge to home, and shorter length of stay in hospital than those who did not receive EXPAREL TAP block.
Further, a significantly higher number of patients treated with EXPAREL TAP block (12%) compared to those without EXPAREL TAP block (3%) consumed no opioids after surgery. Fewer patients treated with EXPAREL TAP block (34%) compared to those without EXPAREL TAP block (50%) reported any adverse events following the delivery.
PainRelief.com: What should readers take away from your report?
Response: Many women experience pain ranging from moderate to severe following cesarean delivery. Poorly-controlled post-cesarean pain can interfere with maternal-infant bonding and can delay recovery. Additionally, the current opioid epidemic in the United States warrants vigilance around opioid prescribing in the hospital and the potential for opioid misuse after surgery. Our findings suggest that the addition of a TAP block with EXPAREL to a multimodal pain management protocol provides effective and improved pain control without the need for high volumes of opioids for women undergoing cesarean deliveries.
Data shows that the use of opioids to manage postsurgical pain poses risks to women. Women are 40 percent more likely than men to become newly persistent opioid users, putting them at risk for dependence and addiction. In this study, we found that 12% of women remained opioid-free, a very encouraging outcome. The data indicate that EXPAREL TAP block in a multimodal pain management protocol can have a real impact on reducing or eliminating the use of opioids while still providing superior pain control after cesarean delivery.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: The study shows that EXPAREL TAP block has been proven to be an effective alternative to opioids for women undergoing cesarean deliveries, an especially important finding because women may be at higher risk of opioid dependence and misuse. It is imperative to continue to study the use of non-opioid options to manage postsurgical pain for multiple demographics during a variety of procedures. EXPAREL is available for many other surgeries, including oral, orthopedic, bariatric, colorectal and plastic surgeries, and can play a role in pain management protocols within each of these practice areas.
Pacira Pharmaceuticals provided support for this study.
Baker BW, Villadiego LG, Lake YN, et al. Transversus abdominis plane block with liposomal bupivacaine for pain control after cesarean delivery: a retrospective chart review. J Pain Res. 2018;11:3109-3116. Published 2018 Dec 10. doi:10.2147/JPR.S184279
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