Subarachnoid block and ultrasound-guided transversalis fascia plane block for caesarean section: A randomised, double-blind, placebo-controlled trial.

ABSTRACT

BACKGROUND: After caesarean section, maternal postoperative comfort is critical to allow the new mother to care for her baby. Insufficient pain relief during the postoperative period may delay maternal/infant bonding and, in addition, such pain has been linked to subsequent depression and chronic pain. Caesarean section is commonly performed with a Pfannenstiel incision, and a transversalis fascia plane (TFP) block provides postoperative analgesia in the T12 and L1 dermatomes. OBJECTIVE: The aim of this study was to investigate the effect of the TFP block on postoperative opioid consumption and pain scores in patients undergoing caesarean section under spinal anaesthesia. DESIGN: A randomised controlled, double-blind study. SETTINGS Single-centre, academic hospital. PARTICIPANTS: Sixty patients undergoing caesarean section. INTERVENTIONS: The TFP group (n = 30) received an ultrasound-guided bilateral TFP block with 20 ml of 0.25% bupivacaine. The control group (n = 30) received 20 ml of saline bilaterally. Postoperative analgesia was given every 6 h with intravenous paracetamol 1 g and patient-controlled analgesia (PCA) with morphine. MAIN OUTCOME MEASURES: Postoperative visual analogue pain scores, morphine consumption, rescue analgesia and opioid-related side effects were evaluated. RESULTS: In the TFP group, the visual analogue pain scores were significantly lower at rest for 2 h after the operation (P = 0.011) and during active movement at 2, 4 and 8 h postoperatively (P = 0.014, <0.001 and 0.032, respectively). Morphine consumption in the first 24 h after surgery was significantly higher in the control group compared with the TFP group (38.5 ±â€Š11.63 and 19.5 ±â€Š8.33 mg, respectively; P < 0.001). The incidence of postoperative nausea and constipation were statistically higher in the control group than in the TFP group (P < 0.05). Patient satisfaction was significantly higher in the TFP group (P = 0.027). CONCLUSION: A postoperative TFP block can reduce opioid consumption and relieve acute pain after a caesarean section under spinal anaesthesia. TRIAL REGISTRATION ClinicalTrials.gov, NCT04172727.