Ideally, the first few days after giving birth should be among the most memorable of any woman’s life—a unique opportunity to bond with her newborn.
Instead, too many women spend those days woozy, nauseated and uncomfortable—the standard after-effects of pain management drugs like morphine, which are typically administered during a Cesarean section.
Now, care teams at The Birthplace at University of Minnesota Medical Center are employing an innovative, targeted pain management method called a TAP block, which has none of the side effects common to opiates or general anesthetics. As a result, C-section moms are more lucid after the birthing experience.
University of Minnesota anesthesiologists are also teaching the TAP block technique to their peers throughout the country; we caught up with Anesthesiologist Jacob Hutchins, MD, to learn more about the technique.
What is a TAP block?
The “TAP” in TAP block stands for the transversus abdominis plane—which refers to a layer of abdominal muscles. The block itself is a highly precise, local anesthetic injected into those muscle to numb up specific nerves near the C-section incision site. Anesthesiologists use ultrasound to guide the needle directly to the targeted area. The pain relief lasts 40 to 72 hours.
How does that differ from traditional methods of pain control?
Before a C-section, patients typically receive a spinal block—an injection of anesthetic near the spine that numbs them from the stomach down. In the past, we would typically give them morphine in that spinal block; it works really well to prevent pain for about 18 to 24 hours. But it wears off, and moms have some pain beyond that. There are also a number of side effects associated with morphine that prove frustrating or difficult for new mothers, who want to hold their baby but may be vomiting or uncomfortable.
Is morphine no longer necessary, then?
That question is actually the subject of current research. There are two types of pain following a C-section—pain from the uterus, and pain where the incision was made. Uterine pain is not covered by the TAP block. So theoretically, there’s still some benefit from the morphine. But uterine pain goes away in six to 24 hours, and we’re going to do a study comparing morphine alone to the TAP block alone. The study will hopefully begin this month.
The TAP block can be used in addition to morphine, or in lieu of it. If you do it with the morphine, mothers get the prolonged effects of pain control. If you do it in lieu of morphine, you still have pain control without the side effects. In the end, we may find that the TAP block will allow us to go with a smaller dose of morphine. The smaller the dose, the less likely mothers are to have the side effects.
Is the University of Minnesota a pioneer in this area?
We are. We participated in one of several studies using TAP blocks to revolutionize pain control for Cesarean patients. TAP blocks have been around for a while, but the use of ultrasound to guide the needle is relatively new. The majority of anesthesiologists around the country don’t know how to do this injection. Our group of anesthesiologists on the Perioperative and Interventional Pain Service (PIPS) are among the most advanced ultrasound-skilled acute pain physicians in the country