Transversus abdominis plane block versus wound infiltration for post-cesarean section analgesia: A systematic review and meta-analysis of randomized controlled trials

Background: Transversus abdominis plane (TAP) block and wound infiltration (WI) with local anesthetics are used for postoperative analgesia after cesarean section (CS), reducing the need for administration of opioids. Objective: To compare the analgesic effect of TAP block related to WI. Search strategy: MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, Cochrane Library, and CINAHL were searched from inception until April 2020. Selection criteria: Randomized controlled trials (RCTs) about women who underwent TAP block or WI after CS. Data collection and analysis: Relevant data were extracted and tabulated. Review Manager 5.3 was used for data analysis. Primary outcome was cumulative opioid consumption (COC) 24 and 48 h after CS. Main results: Five RCTs, enrolling 268 women, were included. There were no significant differences between the interventions regarding COC at 24 (mean difference [MD] –1.68, 95% confidence interval [CI] –6.29 to 2.93) and 48 hours (MD 1.28, 95% CI –10.44 to 13.00). Adverse effects (relative risk [RR] 0.93, 95% CI 0.75–1.16), gastrointestinal reactions (RR 1.30, 95% CI 0.46–3.68), or mild-moderate sedation (RR 1.12, 95% CI 0.72–1.74), pain scores, satisfaction of women, and withdrawals were similar between groups. Conclusions: There might be no significant advantages selecting TAP block over WI for post-CS analgesia.