Bilevel Erector Spinae Plane Block Versus Transversus Abdominis Plane Block for Analgesia After Cesarean Delivery Under Spinal Anesthesia: A Randomized Controlled Trial

Optimizing analgesia after cesarian delivery is an essential element of enhancing maternal recovery, as it supports earlier mobilization, thereby reducing the risk of thromboembolic complications. A multimodal analgesic approach incorporating truncal blocks can provide effective pain relief with minimal side effects for both mother and infant. Epidural or intrathecal administration of morphine is the gold standard for post-cesarean analgesia and forms a cornerstone of multimodal pain management strategies.

In recent years, regional anesthesia techniques are increasingly employed to enhance analgesia and minimize systemic opioid use. These include local anesthetic wound infiltration, ilioinguinal/iliohypogastric nerve blocks, and intraperitoneal anesthetic instillation. Fascial plane blocks such as transversus abdominis plane (TAP), quadratus lumborum (QL), and erector spinae plane (ESP) blocks are also employed to target both somatic and visceral pain effectively.The TAP block is widely used for post-cesarean pain relief by blocking the anterior rami of spinal nerves supplying the abdominal wall through local anesthetic spread between the internal oblique and transversus abdominis muscles. While it offers effective somatic analgesia, it lacks visceral pain relief. The posterior TAP block may provide enhanced effect due to possible retrograde spread to the paravertebral space.The ESP block has emerged as a valuable component of multimodal pain management, providing effective postoperative analgesia for various surgeries, including cesarean delivery. It primarily targets the dorsal rami, with potential spread to the ventral rami through paravertebral space, offering broad and segmental analgesic coverage. The block's simplicity, safety, and opioid-sparing effects especially in low thoracic applications have contributed to its growing use in abdominal surgeries.Although early research suggests that the ESP block may reduce pain and opioid consumption following cesarean delivery, conclusive evidence of its superiority over the TAP block is still lacking. Therefore, this study aims to compare the analgesic efficacy of TAP and bilevel ESP blocks in patients undergoing cesarean delivery under spinal anesthesia.

Aim of the study:

This study aims to compare the bilateral bilevel ESP block with the bilateral TAP block for analgesia after cesarean delivery performed under spinal anesthesia.

Sample Size Calculation: