Transversus Abdominis Plane (TAP) Block for Cesarean Section

Acute severe pain after cesarean section (CS) occurs more often than is thought and 10-15% of
the women having a cesarean section develop chronic pain (Kehlet et al. 2006). With over 1.3
million cesarean deliveries per year in the US, this is bound to create a significant health
problem. One way to address this health burden is to refine techniques that may help control
the pain women experience after CS and ultimately reduce the potential to develop chronic
pain.

The purpose of this randomized, double-blinded study is to evaluate the ability of an
established anesthetic technique called the transversus abdominis plane (TAP) block to reduce
the amount of hyperalgesia women develop around their incision after CS. Measuring the amount
of punctuate mechanical hyperalgesia is used as a tool to assess postoperative central
sensitization (Lavand'homme et al. 2005), which contributes to postoperative acute pain.
Since postoperative acute pain has been shown to be predictive of developing postoperative
chronic pain (Eisenach et al. 2008; Yarnitsky et al. 2008), an effective TAP block could help
diminish the incidence of chronic pain after CS. In addition, blood samples will be collected
for future genetic analysis and we will test preoperatively for mechanical temporal summation
(mTS) to evaluate CNS (central nervous system) sensitization and nociceptive system
hyperexcitability and see if this correlates with the amount of hyperalgesia women develop
around their incision after surgery.

The primary aim of this study is to evaluate the benefits of two different solutions injected
by TAP block technique on postoperative peri-incisional hyperalgesia.

Inclusion Criteria:

- non-laboring women who will benefit from and have clinically consented to a scheduled
or non-scheduled cesarean delivery under spinal anesthesia

- English speaking (UW Site) or Portuguese speaking (Brazil site)

- aged between 18 and 45 years

- BMI < 40

- ASA physical status class I or II

Exclusion Criteria:

- laboring women undergoing a non-scheduled cesarean delivery

- non-English speaking (UW Site) or non-Portuguese speaking (Brazil site)

- previous spinal surgery

- contraindications for neuraxial anesthesia

- allergy to local anesthetic, ultrasound conduction gel, or Clonidine

- history of chronic pain

- inability to receive intraoperative Toradol