Design: Single-centre, three-arm randomised controlled trial
Population: 150 healthy women having elective caesarean under combined spinal-epidural
Primary outcome: 24-hour intravenous sufentanil consumption
Effect: I-TAP vs TAP −11.4 µg (95% CI −17.6 to −5.3); vs sham −23.2 µg (−29.4 to −17.1)

A single-centre Chinese trial randomised 150 women having elective caesarean under combined spinal-epidural anaesthesia to an ultrasound-guided ilioinguinal-transversus abdominis plane (I-TAP) block, a conventional TAP block, or a sham block. Both active blocks used 266 mg liposomal bupivacaine with 50 mg plain bupivacaine in 60 mL. All groups also received epidural hydromorphone.

At 24 hours, the I-TAP group used 11.4 µg less intravenous sufentanil than the TAP group (95% CI −17.6 to −5.3), a 37% reduction, and 23.2 µg less than sham. The difference held at 48 hours, with better pain scores, quality-of-recovery scores and satisfaction, and no excess adverse events.

The rationale is anatomical: a standard TAP block can miss the L1 dermatome that a Pfannenstiel incision crosses. The I-TAP approach is designed to cover it.

This is one centre, and sufentanil consumption is a surrogate for what matters to the mother. Liposomal bupivacaine is costly and not widely stocked in Indian hospitals; whether plain bupivacaine in the same plane gives a similar gain is not tested here.

Discuss with your anaesthetic team whether TAP blocks after caesarean reliably cover the L1 dermatome.
Treat this as one single-centre trial, not yet a reason to change a working protocol.
Check whether liposomal bupivacaine is available and affordable before considering the technique.
Keep neuraxial opioid as the foundation of post-caesarean analgesia — every group here had it.

Why it matters

It suggests some post-caesarean pain persists because standard TAP blocks miss the incision's nerve supply.

The statistics, in plain English

The confidence interval of −17.6 to −5.3 µg does not cross zero, so the I-TAP group very likely used less opioid. Whether 11 µg of sufentanil over a day is clinically important is a separate question — the better pain and recovery scores suggest it may be.