Question

A 23-year-old woman just had a stat cesarean section under general anesthesia for fetal bradycardia. She is having severe incisional pain despite intravenous opiates and she is concerned about opiates and breastfeeding. Injection of a local anesthetic in which of the following spaces will lead to reliable analgesia for this patient?

A. Injection deep to the transversus abdominis muscle
B. Injection just superficial to the external oblique muscle
C. Injection in the plane between the external oblique and internal oblique muscles
D. Injection in the midline just cephalad to the incision
E. Injection between the transversus abdominis muscle and the internal oblique muscle

Answer 1

Injection deep to the transversus abdominis muscle (transversus abdominis plane or TAP block) will lead to reliable analgesia for the patient after cesarean section, providing effective pain management while avoiding the systemic effects of opioids.

Step-by-step explanation:

The best choice for injection of local anesthetic to provide reliable analgesia after a cesarean section is injection deep to the transversus abdominis muscle, which is option A. This technique is known as a transversus abdominis plane (TAP) block. The TAP block targets the sensory nerves that supply the abdominal wall. By injecting local anesthetic into the plane between the internal oblique and the transversus abdominis muscles, the drug can reach the nerves of the thoracolumbar origins (T10 to L1), which are responsible for the sensory innervation to this area.

Local anesthetics are a crucial component of pain management strategies, especially in postoperative care. A TAP block can provide effective analgesia without the systemic effects of opioids, which is particularly beneficial for breastfeeding mothers who are concerned about the transfer of medication to their baby.