he American Society of Anesthesiologists (2016) recommends neuraxial opioids for postoperative analgesia. Although most cesarean deliveries in the United States are performed under neuraxial anesthesia, in certain situations a peripheral nerve block such as a transversus abdominis plane (TAP) block may be considered (McDonnell, 2007). hese include cases in which the parturient did not receive neuraxial opioids, underwent general anesthesia, or has persistent pain following neuraxial anesthesia. It is usually performed under ultrasound guidance and involves injection of a local anesthetic into the transversus abdominis plane between the internal oblique and transversus abdominis muscles. he nerves lying in this plane supply the anterior abdominal wall at the T 6 to L1 dermatomes. A metaanalysis of 31 controlled trials showed that ultrasoundguided TAP block marginally reduced opioid consumption at 6 hours following abdominal surgery (Baeriswyl, 2015).
Abrao KC, Francisco RP, Miyadahira S, et al: Elevation of uterine basal tone and fetal heart rate abnormalities after labor analgesia: a randomized controlled trial. Obstet Gynecol 113(10):41,2009
Alexander JM, Sharma SK, McIntire DD, et al: Epidural analgesia lengthens the Friedman active phase ofolabor. Obstet Gynecol 100:46,o2002
American College of Obstetricians and Gynecologists: Practice advisory: FDA warnings regarding use of general anesthetics and sedation drugs in young children and pregnant women. 2016a. Available at: http://www.acog.org/ About-ACOG/News-Room/Practice-Advisories/FDA-Warnings-Rega rding-Use-of-General-Anesthetics-and-Sedation-Drugs. Accessed January 30, 20o17
American College of Obstetricians and Gynecologists: hrombocytopenia in pregnancy. Practice Bulletin 166, September 20o16b American College of Obstetricians and Gynecologists: Obstetric analgesia and anesthesia. Practice Bulletin 177, Aprilo20o17a
American College of Obstetricians and Gynecologists: Oral intake during labor. Committee Opinion No. 44o1, September 2009, Reairmed 20o17b
American Society of Anesthesiologists: Task Force on Obstetrical Anesthesia: practice guidelines for obstetrical anesthesia. Anesthesiology 124:270, 20o16
Angle P, Tang SL, Thompson D, et al: Expectant management of postdural puncture headache increases hospital length of stay and emergency room visits. Can J Anaesth 52(4):397, 2005