Comparative efficacy of transversalis fascia plane block and transversus abdominis plane block for postoperative pain management following cesarean delivery: a systematic review and meta-analysis.
Mahmoud Bahr, Saeed Baradwan, Wael Mohamed Elmahdi Ibrahim, Othman Saadeldien Yahia, Reda A Ismail, Abizer Juzer Firoz, Nahla Mohammed Eldeeb, Doaa Mohamed Almonayery, Ahmed Mohamed Abdelhakim, Doaa Moaz Sayem
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Abstract
Background: Cesarean section is among the most widely performed obstetric procedures globally and is frequently complicated by moderate to severe postoperative pain. The transversalis fascia plane block (TFPB) and transversus abdominis plane block (TAPB) are regional anesthetic techniques commonly used for post-cesarean analgesia. This study aimed to compare the analgesic effectiveness of TFPB versus TAPB in women undergoing cesarean section under spinal anesthesia.
Methods: PubMed, Scopus, Cochrane Library, and Web of Science were searched from inception through December 2025 for randomized controlled trials (RCTs) comparing TFPB with TAPB in women undergoing cesarean delivery. The primary outcome was pain scores during movement assessed by the numeric rating scale (NRS). Secondary outcomes included cumulative 24-h opioid consumption, requirement for rescue analgesia, time to first request for postoperative analgesia, and patient satisfaction.
Results: Six RCTs encompassing 491 participants met the inclusion criteria. Compared with TAPB, TFPB was associated with lower NRS pain scores during movement at 6, 12, and 24 h postoperatively. TFPB was further associated with lower total opioid requirements, a reduced likelihood of needing rescue analgesia, a prolonged interval to the first analgesic request, and higher patient-reported satisfaction scores.
Conclusions: Among women undergoing cesarean section under spinal anesthesia, TFPB appears associated with better short-term analgesic outcomes compared with TAPB, reflected by lower pain scores, decreased opioid requirements, reduced rescue analgesia use, and higher patient satisfaction. However, substantial heterogeneity and limited sample size warrant cautious interpretation. Larger, adequately powered, and methodologically standardized RCTs are warranted to confirm these findings.
背景：剖宫产是全球实施最广泛的产科手术之一，通常伴有中度至重度术后疼痛。横筋膜平面阻滞（TFPB）和横腹平面阻滞（TAPB）是剖宫产后镇痛常用的区域麻醉技术。本研究旨在比较脊髓麻醉下剖宫产术中TFPB与TAPB的镇痛效果。方法：检索PubMed、Scopus、Cochrane Library和Web of Science从成立到2025年12月的随机对照试验（rct），比较剖宫产妇女TFPB和TAPB。主要结果是通过数字评定量表（NRS）评估运动时的疼痛评分。次要结局包括累计24小时阿片类药物消耗、抢救镇痛需求、首次要求术后镇痛的时间和患者满意度。结果：6项随机对照试验共纳入491名受试者，符合纳入标准。与TAPB相比，TFPB在术后6、12和24小时运动时的NRS疼痛评分较低。TFPB与较低的阿片类药物总需要量、较低的需要抢救性镇痛的可能性、较长的首次镇痛请求间隔以及较高的患者报告满意度得分有关。结论：在脊柱麻醉下剖宫产的妇女中，与TAPB相比，TFPB似乎与更好的短期镇痛结果相关，反映在更低的疼痛评分、更少的阿片类药物需求、更少的抢救镇痛使用和更高的患者满意度。然而，大量的异质性和有限的样本量需要谨慎的解释。为了证实这些发现，有必要进行更大规模、更有力、方法标准化的随机对照试验。
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