Abstract
Author(s): Khaled M. Alanwer, Ahmed Alaa-din Wali, Mohamed Mohamed Hegab, Bahaa G. Mohamed
Background: Caesarean section is a common surgery with significant postoperative pain. While fascial plane blocks are recommended, the optimal technique remains debated. This study compared the analgesic efficacy of ultrasound-guided Transversalis Fascia Plane (TFP) block vs.Transversus Abdominis Plane (TAP) block for post-caesarean recovery. Patients and methods: This single-centre retrospective cohort study analyzed data from 73 patients (TFP n=34, TAP n=39) undergoing elective caesarean delivery under spinal anesthesia between June 2021 and May 2022 in Saudi German Hospital in Saudi Arabia. Patients received either a TFP or TAP block with 20 mL 0.25% bupivacaine per side postoperatively. All patients received standardized multimodal analgesia and Patient-Controlled Analgesia (PCA) with morphine. The primary outcome was 24-hour morphine consumption. Secondary outcomes included pain scores (NRS), time to first PCA bolus, time to PCA depletion, morphine consumption at 24-48 hours, opioid-related side effects, and functional recovery milestones (time to ambulation and flatus). Results: The TFP group had significantly lower 24-hour morphine consumption (15.65 mg vs. 22.80 mg, p<0.001) and lower NRS scores at all time points (2–24 h, p<0.05). Time to first PCA bolus was longer with TFP (5.2 h vs. 2.8 h, p<0.001), and time to PCA depletion was significantly delayed (32.5 h vs. 25.8 h, p<0.001). Morphine consumption remained lower in the TFP group during the 24-48 hour period (8.20 mg vs. 12.50 mg, p<0.001). Functional recovery was faster in the TFP group for both ambulation (16.5 h vs. 19.8 h, p=0.002) and return of flatus (20.1 h vs. 23.5 h, p=0.034). No significant differences in side effects were observed. No block-related complications (LAST, haematoma, or infection) in either group.Conclusion: In this retrospective analysis, the TFP block was associated with superior analgesia, prolonged pain control, and enhanced recovery compared to the TAP block. The technique demonstrated an excellent safety profile with no complications reported. These findings suggest that the TFP block is a promising technique that warrants further investigation in randomized controlled trials to confirm its efficacy and support its adoption into clinical practice.