Post-cesarean analgesia: transversalis fascia plane block versus wound infiltration in a randomized trial

The aim of this study was to compare ultrasound-guided transversalis fascia plane block with local wound infiltration using equivalent local anesthetic doses within a standardized multimodal analgesia protocol.

This prospective, single-blind randomized trial was conducted between May and June 2024 at a tertiary care hospital. Women with American Society of Anesthesiologists physical status II-III undergoing cesarean delivery under spinal anesthesia received either bilateral ultrasound-guided transversalis fascia plane block or local wound infiltration with the same total dose and volume of bupivacaine. All patients were managed with standardized multimodal analgesia. Patients with contraindications to the study interventions or inability to use patient-controlled analgesia were excluded. The primary outcome was 24-h opioid consumption. Secondary outcomes included pain scores, rescue analgesia use, opioid-related adverse events, and complications.

Forty-two patients (n=21/group) were analyzed. Twenty-four-hour opioid consumption was similar between transversalis fascia plane block and local wound infiltration groups (median 100 [65-152] mg vs. 85 [65-135] mg; p=0.554). Pain scores remained low and comparable throughout 48 h. Rescue analgesia was rarely required, and no postoperative nausea, opioid-related adverse events, or procedure-related complications were observed.

In a standardized multimodal analgesia setting after cesarean delivery, transversalis fascia plane block did not reduce opioid consumption or improve postoperative pain scores compared with local wound infiltration.