An ultrasound-guided transversalis fascia plane block, or TFPB, did not show a clear short-term advantage over local wound infiltration, or LWI, after cesarean delivery, according to a randomized trial of 42 women. Opioid use was similar over 24 hours, and pain scores remained similar through 48 hours.
The primary result was numerically higher with the block: median 24-hour tramadol consumption was 100 mg with TFPB, compared with 85 mg with LWI. The reported 95% confidence interval spanned minus 30.12 to 51.27 mg, while the p-value was 0.554. The difference was not statistically significant, and median consumption at all other predefined intervals was also comparable.
Pain scores remained low and comparable between groups through 48 hours, with median scores below 3 out of 10 across the measured intervals. Three patients in the LWI group, or 14.2%, required rescue analgesia, compared with none in the TFPB group. The difference was not statistically significant, with a reported p-value of 0.072.
How the comparison was set up
The researchers ran a prospective, single-blinded randomized controlled trial that had ethics approval and was registered at ClinicalTrials.gov before enrollment. It included women with ASA physical status II to III undergoing cesarean delivery under spinal anesthesia. A computer-generated sequence and sequentially numbered opaque sealed envelopes determined allocation. Baseline demographic and clinical characteristics were reported as comparable, with no statistically significant differences.
The two groups received the same local-anesthetic dose and volume: 40 mL of 0.25% bupivacaine in each group. One group received ultrasound-guided TFPB, while the surgeon performed LWI in the other; both groups also received standardized multimodal analgesia. Patients and the postoperative pain team were blinded, while one anesthesiologist performed TFPB.
The main outcome was total tramadol consumption during the first 24 hours. Secondary measures included pain scores, rescue analgesia when the numerical rating scale was above 3, opioid-related adverse events and procedure-related complications.
A result with a narrow reach
The sample-size plan relied on retrospective pilot data from 12 patients per group that suggested an approximately 37% reduction. The calculation required 19 patients per group; 21 per group, 42 total, were planned after allowing for 10% dropout. The paper identifies the pilot-based effect estimate as a possible source of overestimation.
There were other reasons to keep the conclusion narrow. The trial included no placebo or sham group, so it could not measure the absolute effect of either local-anesthetic technique against no regional block. The paper also notes possible assessment bias because the anesthesiologist who performed TFPB assessed block success, and it did not evaluate how long the block lasted.
No postoperative nausea and vomiting requiring medication, listed opioid-related side effects or procedure-related complications were observed in either group. Those zero-event findings do not provide reliable estimates of rare complications in a study of 42 patients.
Within the studied setting, among women receiving spinal anesthesia and standardized multimodal analgesia, TFPB showed no measurable short-term opioid or pain advantage over LWI. The trial therefore answers a narrower question than whether the techniques are equivalent or how TFPB performs against a sham or no regional-block control.
The paper reports no funding, and the authors declare no conflicts of interest.
Paper data and sources
Original title: Post-cesarean analgesia: transversalis fascia plane block versus wound infiltration in a randomized trial
Authors: Teomete G, Öztürk E, Çimenoğlu I et al.
Journal/Repository: Revista da Associacao Medica Brasileira (1992)
Status: Peer-reviewed
First online: 2026-10-19
DOI: Not available
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