- Design
- Single-centre, single-blind randomised trial
- Population
- 42 women having caesarean section under spinal anaesthesia
- Primary outcome
- 24-hour opioid consumption
- Effect
- Median 100 mg vs 85 mg, p = 0.554
In this single-blind randomised trial at one tertiary hospital, 42 women having caesarean section under spinal anaesthesia received either a bilateral ultrasound-guided transversalis fascia plane block or wound infiltration with the same dose and volume of bupivacaine. Everyone also received a standard multimodal analgesia regimen.
Median 24-hour opioid use was 100 mg (interquartile range 65 to 152) with the block and 85 mg (65 to 135) with infiltration, p = 0.554. Pain scores were low and similar for 48 hours, rescue analgesia was rarely needed, and no complications were recorded in either group.
Where multimodal analgesia is already in place, a surgeon-delivered wound infiltration appears to do as well as a block that needs ultrasound, an anaesthetist's time and a second procedure. The trial is small, so it cannot exclude a modest difference, and it does not apply to units without a multimodal regimen.
- Make sure a full multimodal regimen is in place before adding a regional block after caesarean.
- Consider wound infiltration as a reasonable alternative where block expertise or ultrasound time is limited.
- Agree local anaesthetic dose and volume between surgeon and anaesthetist to avoid duplication.
- Keep a block for women who cannot have standard multimodal agents or who have poorly controlled pain.
Why it matters
Adding a block to good multimodal care may cost theatre time without adding pain relief.
Don't overread it
With 42 women, the trial was too small to establish that the two techniques are equivalent.
The statistics, in plain English
A p value of 0.554 means the difference in opioid use was well within what chance would produce. With only 21 women per group, the trial could miss a small real difference, so this is a 'no clear benefit' result rather than proof of equivalence.
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