TAP Block Versus ESP Block in Patients Undergoing Elective Cesarean Section: a Randomized Controlled Trial

This study is a prospective, monocentric, randomized controlled trial designed to compare the analgesic efficacy of the transversus abdominis plane (TAP) block versus the erector spinae plane (ESP) block in women undergoing elective cesarean section. Cesarean delivery, one of the most commonly performed surgical procedures worldwide, is associated with both somatic and visceral postoperative pain. Optimizing pain control is critical not only for maternal comfort but also for reducing complications, facilitating early mobilization, and supporting breastfeeding and maternal-infant bonding. While the TAP block provides effective somatic analgesia of the abdominal wall with a rapid learning curve, it does not address visceral pain. Conversely, the ESP block offers multidermatomal coverage, potentially reducing both somatic and visceral components of postoperative pain and opioid consumption. The primary objective of the study is to evaluate postoperative pain at rest six hours after surgery, with secondary outcomes including pain at various time points, opioid consumption, time to first rescue analgesia, ambulation, and initiation of breastfeeding.

A total of 156 patients meeting inclusion criteria (age 18-45 years, elective cesarean, informed consent) will be randomized to receive either a bilateral TAP or ESP block following standardized spinal anesthesia. Pain scores will be assessed using an 11-point Numeric Rating Scale (NRS) at 6, 12, and 24 hours postoperatively, both at rest and with movement. Opioid use, time to ambulation, and breastfeeding initiation will also be recorded. The study is powered to detect a clinically significant difference in pain scores, and data analysis will include tests for normality, parametric and non-parametric comparisons, repeated-measures analysis, regression models, and survival analysis for time-to-event outcomes. The trial adheres to ethical standards, including informed consent and data privacy, and the results will be disseminated regardless of outcome, contributing to evidence-based practice in post-cesarean analgesia.

• Pain at Rest at 12 hours [Срок оценки: 12 hours after end of surgery]
• Pain at Rest at 24 hours [Срок оценки: 24 hours after end of surgery]
• Pain at Movement at 6 hours [Срок оценки: 6 hours after end of surgery]
• Pain at Movement at 12 hours [Срок оценки: 12 hours after end of surgery]
• Pain at Movement at 24 hours [Срок оценки: 24 hours after end of surgery]
• Milligram of Morphine equivalents in the first 24 postoperative hours [Срок оценки: from the end of the surgery to 24 hours after the surgery]
• Time to rescue analgesic requirement [Срок оценки: Form the end of the surgery to the first rescue analgesic requirement (up to o 24 hours after the surgery)]
• Time to breast feeding [Срок оценки: Form the end of the surgery to the start of breast feeding (up to o 24 hours after the surgery)]
• Time to deambulate [Срок оценки: Form the end of the surgery to the start of deambulation (up to o 24 hours after the surgery)]