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 (nâ=â30) received an ultrasound-guided bilateral TFP block with 20âml of 0.25% bupivacaine. The control group (nâ=â30) received 20âml of saline bilaterally. Postoperative analgesia was given every 6âh 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 2âh after the operation (Pâ=â0.011) and during active movement at 2, 4 and 8âh postoperatively (Pâ=â0.014, <0.001 and 0.032, respectively). Morphine consumption in the first 24âh after surgery was significantly higher in the control group compared with the TFP group (38.5â±â11.63 and 19.5â±â8.33âmg, respectively; Pâ<â0.001). The incidence of postoperative nausea and constipation were statistically higher in the control group than in the TFP group (Pâ<â0.05). Patient satisfaction was significantly higher in the TFP group (Pâ=â0.027). 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.