Unilateral Transversus Abdominis Plane Block Catheter for the Treatment of Abdominal Wall Pain in Pregnancy
Bibliographic record
Abstract
OBJECTIVE: The transversus abdominis plane (TAP) block anesthetizes the anterior branches of spinal nerves that innervate the abdominal wall from T6 to L1 dermatomes and provide effective postoperative analgesia after abdominal surgery. Several applications of TAP catheters are described for both acute and chronic abdominal wall pain, but there are no reported cases of TAP catheters used during pregnancy. CASE REPORT: We present the case of a 23-year-old primigravida admitted to the hospital on multiple occasions during her pregnancy for right lower quadrant abdominal "stabbing" pain, with a visual analog scale score intensity of 8/10 abdominal pain. The diagnosis was unclear despite the presence of prominent ileocolic lymph nodes visualized on magnetic resonance imaging. The abdominal pain persisted despite escalating doses of intravenous opioids (up to 30 mg of intravenous hydromorphone daily). At 34 weeks' gestation, a right-sided TAP block with 0.25% bupivacaine was inserted under ultrasound guidance, and this relieved all of her pain (visual analog scale score, 0). The patient was managed with repeated boluses of 0.5% ropivacaine via a TAP catheter, which resulted in complete resolution of her pain within 3 days and allowed for complete discontinuation of opioid medications. The patient was discharged home, with no recurrence of pain. She had an uneventful cesarean delivery at term. CONCLUSIONS: A TAP catheter inserted under ultrasound guidance can be effective for the treatment of chronic abdominal pain during pregnancy and may provide an alternative analgesic modality when intravenous opioids are not providing relief or when neuraxial analgesia techniques are not feasible or contraindicated.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".