Intrathecal morphine versus transversalis fascia and transversus abdominis plane blocks combination on obstetric quality of recovery after cesarean delivery: a randomized controlled trial.

BACKGROUND: The transversus abdominis plane (TAP) block is widely used to enhance postoperative analgesia after cesarean sections (CS). This study aimed to compare the effect of combining the transversalis fascia plane (TFP) block with the TAP block versus intrathecal morphine (ITM) on postoperative recovery quality assessed using the Obstetric Quality of Recovery-10 (ObsQoR-10T) score. METHODS: This prospective, randomized clinical trial was conducted at a single university hospital. One hundred patients undergoing elective CS under spinal anesthesia were randomized into two groups. Group ITM received spinal anesthesia comprising 10 mg 0.5% hyperbaric bupivacaine, 15 µg fentanyl, and 100 µg morphine. Group TAP + TFP received spinal anesthesia with 10 mg of 0.5% hyperbaric bupivacaine and 15 µg of fentanyl, without intrathecal morphine. In the TAP + TFP group only, bilateral TAP and TFP blocks were performed at the end of surgery, whereas no block was administered in the ITM group. Postoperative analgesia was provided using fentanyl-based patient-controlled analgesia (PCA). The primary outcome was the ObsQoR-10T score which was assessed at 24 h postoperatively. Secondary outcomes included opioid consumption, pain scores at rest and movement, adverse effects, and patient satisfaction. RESULTS: There was no significant difference between the groups regarding the total ObsQoR-10T scores (91.72 ± 6.46 vs. 91.56 ± 5.54, p = 0.895). The TAP + TFP group had significantly higher fentanyl consumption at 24 h compared to the ITM group (187.50 µg vs. 87.50 µg, p = 0.005). No significant differences were found in pain scores at rest or during movement. The incidence of adverse effects and patient satisfaction rates were comparable between groups. CONCLUSIONS: The TAP + TFP block combination yielded a similar overall ObsQoR-10T recovery profile to ITM. Both strategies provided satisfactory analgesia and high maternal satisfaction. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID: NCT06944912 retrospectively registered at clinicaltrials, principal investigator: Ali Ahiskalioglu (registration date: April 18, 2025).