The Analgesic Effect of Transversalis Fascia Plane Block After Cesarean Delivery: A Systematic Review and Meta-Analysis With Trial Sequential Analysis

Abstract

Introduction: The transversalis fascia plane block (TFPB) has been utilized for pain relief following cesarean delivery (CD) but its analgesic efficacy remains controversial. This systematic review and meta-analysis with trial sequential analysis, aimed to evaluate the effectiveness of TFPB in providing postoperative analgesia for patients undergoing CD. Evidence acquisition: A comprehensive literature search was conducted to identify trials comparing TFPB with a control group in CD patients. The primary outcome was opioid consumption within the first 24 hours postoperatively. Secondary outcomes included pain scores at rest and during movement at 12 and 24 hours, incidence of postoperative nausea and vomiting (PONV), and the need for rescue analgesia. Evidence synthesis: Seven studies involving a total of 478 patients (240 in the TFPB group and 238 in the control group) met the inclusion criteria. Patients in the TFPB group demonstrated significantly lower opioid consumption within the first 24 hours postoperatively, with a mean difference (MD) of -5.80 mg of morphine equivalents (95% CI -9.13 to -2.47; P<0.001). Additionally, the likelihood of requiring rescue analgesia was significantly reduced in the TFPB group, with an odds ratio (OR) of 0.28 (95% CI 0.14 to 0.55; P<0.001). However, there were no statistically significant differences in pain scores at rest or during movement at 12 and 24 hours postoperatively. Conclusions: This systematic review and meta-analysis suggests that TFPB may reduce opioid consumption and the need for rescue analgesics in patients undergoing CD. However, its effect on postoperative pain scores remains inconclusive, highlighting the need for further research to better understand its clinical benefits.