Ilioinguinal-Transversus Abdominis Plane (I-TAP) Block with Liposomal Bupivacaine for Analgesia After Cesarean Delivery: A Randomized Controlled Trial.

Abstract

Cesarean delivery is frequently associated with suboptimal postoperative analgesia. While PROSPECT guidelines recommend transversus abdominis plane (TAP) block for post-cesarean analgesia, conventional TAP block may provide incomplete coverage of the L1 dermatome, potentially limiting analgesia for lower abdominal incisions. This study evaluated the efficacy and safety of ultrasound-guided ilioinguinal-transversus abdominis plane (I-TAP) block with liposomal bupivacaine after cesarean delivery. In this single-center, randomized controlled trial, 150 healthy parturients undergoing elective cesarean delivery under combined spinal-epidural anesthesia were allocated in a 1:1:1 ratio to I-TAP block, transversus abdominis plane (TAP) block, or sham block. The I-TAP and TAP blocks were performed using a mixture of 266 mg liposomal bupivacaine and 50 mg bupivacaine hydrochloride, diluted with 0.9% sodium chloride to a total volume of 60 mL. The primary outcome was the cumulative intravenous sufentanil consumption from the patient controlled intravenous analgesia (PCIA) device during the first 24 h after surgery. Secondary outcomes included 48 h PCIA sufentanil requirements, Quality of Recovery-15 (QoR-15) scores, pain scores, time to first rescue analgesia, time to ambulation, successful breastfeeding initiation, maternal satisfaction, and adverse events. At 24 h postoperatively, the I-TAP group had significantly lower sufentanil consumption than the TAP group (mean difference -11.4 μg, 95% CI: -17.6 to -5.3; 37.1% reduction) and the control group (mean difference -23.2 μg, 95% CI: -29.4 to -17.1; 54.5% reduction) (both P < 0.001). This difference persisted at 48 h. The I-TAP group also had lower postoperative pain scores, higher QoR-15 scores, longer time to first opioid rescue request, higher maternal satisfaction and higher rate of successful breastfeeding initiation. Adverse events were similar among groups. Compared with TAP block plus epidural hydromorphone and epidural hydromorphone alone, liposomal bupivacaine I-TAP block combined with epidural hydromorphone significantly reduced post-cesarean PCIA sufentanil requirements, improved postoperative analgesia and recovery quality, and increased maternal satisfaction without evidence of increased adverse events. This technique may provide a safe and effective option for implementation within multimodal analgesic strategy after cesarean delivery. ChiCTR2500112390.