Transversus Abdominis Plane Block for Analgesia after Cesarean Section

Abstract

Introduction: Post-cesarean pain management affects maternal recovery, breastfeeding, and opioid exposure to the newborn. This review assesses transversus abdominis plane block efficacy compared to standard systemic analgesia.

Methods: Literature review identified randomized trials comparing ultrasound-guided transversus abdominis plane block (with long-acting local anesthetic) versus systemic opioids or non-steroidal anti-inflammatory drugs in women undergoing cesarean section under spinal or epidural anesthesia. Primary outcome was pain scores at 24 hours. Secondary outcomes included opioid consumption and time to first ambulation.

Results: Twenty-two trials (2,847 patients) were included. Transversus abdominis plane block reduced pain scores at rest by 1.4 points on a 0-10 scale at 24 hours and by 1.1 points during movement. Intravenous morphine equivalents consumed over 24 hours decreased by 39%. Time to first ambulation was earlier by 2.2 hours. No differences in block-related complications were noted.

Discussion: The block targets the thoracolumbar nerves supplying the anterior abdominal wall, complementing visceral pain covered by neuraxial morphine. Efficacy is greater when combined with multimodal systemic analgesia rather than as a standalone technique. Heterogeneity in local anesthetic concentration and volume may influence outcomes.

Conclusions: Transversus abdominis plane block provides meaningful but modest analgesia after cesarean section, reducing opioid requirements and facilitating early mobilization. It is a useful component of multimodal analgesia.