In females undergoing cesarean delivery, the use of liposomal bupivacaine TAP block with or without intrathecal morphine led to statistically non-inferior postsurgical opioid intake through 72 hours, decreased pruritus severity, and exhibited a favorable safety profile in comparison with intrathecal morphine alone.

A study was carried out to determine the efficacy and safety of liposomal bupivacaine transversus abdominis plane (TAP) block with or without the long-acting intrathecal opioids vs. intrathecal opioids alone for postsurgical analgesia following elective cesarean delivery.

This randomized, open-label, multicenter trial [CHOICE] enrolled 153 females with a term pregnancy of 37 to 42 weeks scheduled for cesarean delivery under spinal anesthesia. Participants were randomly allocated to (i) Liposomal bupivacaine group (n=52): Received 266 mg liposomal bupivacaine TAP block alone, (ii) Liposomal bupivacaine + intrathecal morphine group (n=48): Received 50 μg intrathecal morphine followed by 266 mg liposomal bupivacaine TAP block, and (iii) Intrathecal morphine group (n=53): Received 150 μg intrathecal morphine alone.

A similar postsurgical multimodal analgesic regimen was given to all three groups. The post-surgical opioid intake in morphine milligram equivalents (MMEs) through 72 hours was evaluated by investigating noninferiority prior to testing superiority. Using an 11-point numerical rating scale (NRS), the severity of postsurgical pruritus was measured.

The liposomal bupivacaine group exhibited non-inferior postsurgical opioid consumption through 72 hours in comparison with the other two groups. The occurrence of adverse events is shown in Table 1:

When compared to the intrathecal morphine group, the other two groups displayed remarkably reduced pruritus severity scores through 12, 24, 48, and 72 hours.

Compared with intrathecal opioids, TAP block with liposomal bupivacaine as part of a multimodal analgesia regimen after cesarean delivery offered non-inferior postsurgical opioid intake through 72 hours and was linked with reduced pruritus severity scores and numerically reduced occurrence of adverse events.