Adding Sufentanil to TAP Block Hyperbaric Bupivacaine Decreases Post-Cesarean Delivery Morphine Consumption

  • Laleh Eslamian Department of Obstetrics & Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Motahareh Kabiri-Nasab Department of Obstetrics & Gynecology Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Marzieh Agha-Husseini Department of Obstetrics & Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Omid Azimaraghi Department of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Gilda Barzin Department of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Ali Movafegh Department of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Keywords: Analgesia, Cesarean delivery, Pain intensity, TAP block


Pain management is crucially important in the postoperative period as it increases patient comfort and satisfaction. The primary outcome of present study was to evaluate the effect of sufentanil added to hyperbaric bupivacaine solution 0.25% in transversus abdominis plane (TAP) block, on postoperative analgesic consumption. Fifty ASA physical status I–II term primiparous single-tone pregnant women aged 20–40 years scheduled for elective cesarean delivery with Pfannenstiel incision under general anaesthesia were enrolled in this randomized, double-blind, placebo-controlled trial. Ultrasound guided TAP block was performed at the end of surgery. Patients were randomly enrolled into two groups. Patients in the study group received 20 ml of hyperbaric bupivacaine 0.25% plus 1mL of sufentanil on either side while patients in the placebo group were administered 20 ml of hyperbaric bupivacaine 0.25% along with 1mL of placebo. Post-cesarean delivery visual analogue scale (VAS) for pain and morphine usage were measured and recorded. The morphine consumption was significantly less in the study group (37.2 ± 16.1 mg) than the control group (52.8 ± 16.7 mg, P =0.002).The VAS for pain both in rest and coughing were same in groups. Sufentanil added to 0.25% hyperbaric bupivacaine in TAP block decreases post cesarean delivery morphine consumption.


Ong CK, Lirk P, Seymour RA, et al. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg 2005;100(3):757-73.

Gadsden J, Hart S, Santos AC. Post-cesarean delivery analgesia. Anesth Analg 2005;101(5 Suppl):S62-9

Bonnet MP, Mignon A, Mazoit JX, et al. Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: a systematic review. Eur J Pain 2010;14(9):894.e1-9.

Wong JY, Carvalho B, Riley ET. Intrathecal morphine 100 and 200 μg for post-cesarean delivery analgesia: a tradeoff between analgesic efficacy and side effects. Int J ObstetAnesth 2013;22(1):36-41.

Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol 2009;22(5):588-93.

Ismail S, Shahzad K, Shafiq F. Observational study to assess the effectiveness of postoperative pain management of patients undergoing elective cesarean section. J Anaesthesiol Clin Pharmacol 2012;28(1):36-40.

Eslamian L, Jalili Z, Jamal A, et al. Transversus abdominis plane block reduces postoperative pain intensity and analgesic consumption in elective cesarean delivery under general anaesthesia. J Anesth 2012;26(3):334-8.

Branch DW, Silver RM. Managing the primary cesarean delivery rate. Clin Obstet Gynecol 2012;55(4):946-60.

Saha S, Saha S, Das R, et al. A Paradigm Shift to Check the Increasing Trend of Cesarean Delivery is the Need of Hour: But How? J Obstet Gynaecol India 2012;62(4):391-7.

Villar J, Valladares E, Wojdyla D, et al. Caesarean delivery rates and pregnancy outcomes: the 2005 WHOglobal survey on maternal and perinatal health in LatinAmerica. Lancet 2006;367(9525):1819-29.

Ismail S, Shafiq F, Malik A. Technique of anaesthesia for different grades of Caesarean section: Cross-sectional study. J Pak Med Assoc 2012;62(4):363-7

Bozkurt N, Kurdoglu M, Kurdoglu Z, et al. Postoperative pain control after cesarean section: can diclofenac sodium be used instead of meperidine? J Matern Fetal Neonatal Med 2009;22(12):1144-50.

Moore A, Costello J, Wieczorek P, et al. Gabapentinimproves postcesarean delivery pain management: arandomized, placebo-controlled trial. Anesth Analg 2011;112(1):167-73.

Siddik SM, Aouad MT, Jalbout MI, et al. Diclofenacand/or propacetamol for postoperative pain management after cesarean delivery in patients receiving patient controlled analgesia morphine. Reg Anaesth Pain Med2001;26(4):310-5.

McDonnell JG, O'Donnell B, Curley G, et al. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: A prospective randomized controlled trial. Anesth Analg 2007;104(1):193-7.

Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 2001;56(10):1024-6.

Siddiqui MR, Sajid MS, Uncles DR, et al. A meta-analysis of the clinical effectiveness of transverse abdominis plane block. J Clin Anesth 2011;111(5):721-35.

Corvetto MA, Echevarría GC, De La Fuente N, et al.Comparison of Plasma Concentrations of Levobupivacaine With and Without Epinephrine for Transversus Abdominis Plane Block. Reg Anesth Pain Med 2012;37(6):633-7.

Bollag L, Richebe P, Siaulys M, et al. Effect of transversusabdominis plane block with and without clonidine on postcesareandelivery wound hyperalgesia and pain. RegAnesth Pain Med 2012;37(5):508-14.

Sindjelic RP, Vlajkovic GP, Davidovic LB, et al. The addition of fentanyl to local anesthetics affects the qualityand duration of cervical plexus block: a randomized, controlled trial. Anesth Analg 2010;111(1):234-7.

Candido KD, Hennes J, Gonzalez S, et al. Buprenorphine enhances and prolongs the postoperative analgesic effect of bupivacaine in patients receiving infragluteal sciaticnerve block. Anesthesiology 2010;113(6):1419-26.

Griffiths JD, Le NV, Grant S, et al. Symptomatic local anaesthetic toxicity and plasma ropivacaine concentrationsafter transversus abdominis plane block for Caesarean section. Br J Anaesth 2013;110(6):996-1000.

Farooq M, Carey MA. A case of liver trauma with a blunt regional anaesthesia needle while performing transversus abdominis plane block. Reg Anesth Pain Med 2008;33(3):274-5.

Scharine JD. Bilateral transversus abdominis plane nerve blocks for analgesia following cesarean delivery: report of 2 cases. AANA J 2009;77(2):98-102.

Wood A. New method of treating neuralgia by the direct application of opiates to the painful points. Edinburgh Med Surg J 1885;82:265.

Craft RM, Henley SR, Haaseth RC, et al. Opioid antinociception in a rat model of visceral pain: systemicversus local drug administration. J Pharmacol Exp Ther 1995;275(3):1535-42.

Shannon HE, Lutz EA. Comparison of the peripheral and central effects of the opioid agonists loperamide and morphine in the formalin test in rats. Neuropharmacology 2002;42(2):253-61.

Reichert JA, Daughters RS, Rivard R, et al. Peripheral and preemptive opioid antinociception in a mouse visceral pain model. Pain 2001;89(2-3):221-7.

Labuz D, Mousa SA, Schafer M, et al. Relative contribution of peripheral versus central opioid receptors to antinociception. Brain Res 2007;1160:30-8.

How to Cite
Eslamian L, Kabiri-Nasab M, Agha-Husseini M, Azimaraghi O, Barzin G, Movafegh A. Adding Sufentanil to TAP Block Hyperbaric Bupivacaine Decreases Post-Cesarean Delivery Morphine Consumption. Acta Med Iran. 54(3):185-190.
Original Article(s)