Transversus abdominis plane block and local anesthetic wound infiltration may offer similar postsurgery analgesia following cesarean section.

A systematic review and meta-analysis with trial sequential analysis was performed to compare the analgesic effect of transversus abdominis plane block and local anaesthetic wound infiltration after cesarean section.

Databases like Web of Science, MEDLINE, Cochrane Central Register of Controlled Clinical Trials, and Embase were explored to find out randomized controlled trials investigating wound infiltration and transversus abdominis plane block following cesarean section. The major endpoint ascertained was pain score during rest (visual analogue scale [VAS]) at 2 hours after surgery, assessed as per the transversus abdominis plane block technique (landmark or ultrasound-guided), multimodal analgesia (yes/no), anesthetic strategy (general /spinal), and intrathecal fentanyl (yes/no).

The secondary endpoints ascertained were total intravenous morphine intake (at 24, 12, and 2 hours), and pain scores during rest at 24 and 12 hours. The rates of block complications, including postsurgery infection, haematoma, visceral injury and local anesthetic systemic toxicity were also assessed.

In total, 7 trials and 475 people were incorporated. No profound inter-group difference was noted in pain score during rest at 2 hours. The findings of the subgroup assessment illustrated no differences related to transversus abdominis plane block technique, presence of multimodal analgesia, anesthetic strategy, or administration of intrathecal fentanyl.

In both the groups, pain scores during rest at 12 hours and intravenous morphine intake at 2 and 12 hours were similar.

Hence, both local anesthetic wound infiltration and transversus abdominis plane block led to a similar reduction in pain scores in females scheduled to undergo cesarean section.