Pain Relief Study of Ultrasound Guided Transverse Abdominis Plane(TAP)Block

Analgesic Efficacy of Ultrasound Guided Transversus Abdominis Plane Block After Cesarean Delivery in Patients With a BMI > 30

The purpose of this study is to determine if injecting a local anesthetic, or numbing medication, above each hip will decrease the amount of narcotic pain medicine that is typically required by a patient after a cesarean delivery. Ultrasound pictures will be used to guide placement of this injection. Either ropivicaine (a type of numbing medication called a local anesthetic) or a placebo (saline) will be injected. For 24 hours, you will be given a button to press when you have pain. When the button is pressed, you will be given a small amount of pain medication called hydromorphone through your IV. You will also be given a pain medication called ketorolac through your IV every 8 hours for 24 hours after surgery.

Inclusion Criteria:

• Age 18 years or over
• ASA class 1 , 2 or 3
• BMI greater than 30 kg/m2 (as recorded at the patient's last clinic appointment or as measured on the day of delivery)
• Scheduled for cesarean section via Pfannenstiel incision (with or without a tubal ligation)
• 150 cm or taller
• Informed consent obtained

Exclusion Criteria:

• ASA class 4
• Age under 18
• Relevant drug allergy
• Contraindication to spinal anesthesia
• Height < 150 cm
• Patient receiving medical therapies considered to result in a tolerance to opioids
• Any other major surgical procedure performed other than cesarean delivery with or without tubal ligation
• Patient with relevant contraindications to ketorolac, such as history of gastrointestinal bleeding or impaired renal function
• Patient refusal