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

This study is comparing two types of pain relief techniques-TAP block and ESP block-for women having an elective cesarean section. Both techniques involve injecting local anesthetic under ultrasound guidance to numb nerves and reduce pain after surgery. The TAP block mainly relieves pain in the abdominal wall, while the ESP block may reduce both abdominal wall and deeper, organ-related pain. The main goal is to see if there's a difference in pain at rest six hours after surgery. The study will also look at pain at later time points, the amount of opioid medication needed, how quickly women can walk, and when they start breastfeeding.

A total of 156 women will be randomly assigned to receive one of the two blocks after standard spinal anesthesia. Pain will be measured using a simple 0-10 scale at 6, 12, and 24 hours, both at rest and during movement. The study follows strict ethical rules, ensures patient privacy, and all results-whether positive or negative-will be shared to help improve pain management after cesarean delivery.

Study Overview

• Status: Recruiting
• Conditions: Cesarean Delivery; Regional Anesthesia Block
• Intervention / Treatment: Procedure: TAP block; Procedure: ESP block

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Estimated): 90
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Lorenzo Alfonsi, MD; Phone Number: +390498213090; Email: lorenzo.alfonsi@aopd.veneto.it

Study Locations

• Italy
  • Padova, Italy, 35127
    • Recruiting
    • University Hospital of Padua

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age between 18 and 45 years
• Elective cesarean section
• Ability to provide informed consent

Exclusion Criteria:

• Allergy to any of the drugs used in the study
• Heart disease with impaired cardiac function
• Stage III or higher kidney failure
• Coagulation disorders (platelets <100,000/μL or INR >1.5) or severe liver disease
• Degenerative central nervous system diseases or peripheral neuropathies
• Previous uterine surgery (e.g., myomectomy)
• Previous cesarean section

Pre-pregnancy weight <55 kg

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: TAP block; Patients will undergo preoperative bilateral TAP block with ropivacaine 0.375% 20 mL per side (total 40 mL)	Procedure: TAP block; TAP block will be performed with with ropivacaine 0.375% 20 mL per side (total 40 mL)
Experimental: ESP block; Patients will undergo preoperative bilateral ESP block with ropivacaine 0.375% 20 mL per side (total 40 mL)	Procedure: ESP block; ESP block will be performed with ropivacaine 0.375% 20 mL per side (total 40 mL)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain at Rest at 6 hours	Pain measured at Rest with Numeric Rating Scale (minimun 0- maximum 10) with 0 meaning no pain and 10 high pain	6 hours after end of surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain at Rest at 12 hours	Pain measured at Rest with Numeric Rating Scale (minimun 0- maximum 10) with 0 meaning no pain and 10 high pain	12 hours after end of surgery
Pain at Rest at 24 hours	Pain measured at Rest with Numeric Rating Scale (minimun 0- maximum 10) with 0 meaning no pain and 10 high pain	24 hours after end of surgery
Pain at Movement at 6 hours	Pain measured at Rest with Numeric Rating Scale (minimun 0- maximum 10) with 0 meaning no pain and 10 high pain	6 hours after end of surgery
Pain at Movement at 12 hours	Pain measured at Rest with Numeric Rating Scale (minimun 0- maximum 10) with 0 meaning no pain and 10 high pain	12 hours after end of surgery
Pain at Movement at 24 hours	Pain measured at Rest with Numeric Rating Scale (minimun 0- maximum 10) with 0 meaning no pain and 10 high pain	24 hours after end of surgery
Milligram of Morphine equivalents in the first 24 postoperative hours	Milligram of Morphine equivalents administered in the first 24 hours	from the end of the surgery to 24 hours after the surgery
Time to rescue analgesic requirement	Time the patients will require the first rescue analgesic requirement measured in minutes	Form the end of the surgery to the first rescue analgesic requirement (up to o 24 hours after the surgery)
Time to breast feeding	Time the patients will breast feed expressed in minutes	Form the end of the surgery to the start of breast feeding (up to o 24 hours after the surgery)
Time to deambulate	Time the patients will deambulate expressed in minutes	Form the end of the surgery to the start of deambulation (up to o 24 hours after the surgery)

Collaborators and Investigators

• Sponsor: University of Padova

Study record dates

Study Major Dates

• Study Start (Actual): January 7, 2026
• Primary Completion (Estimated): October 1, 2027
• Study Completion (Estimated): October 1, 2027

Study Registration Dates

• First Submitted: September 12, 2025
• First Submitted That Met QC Criteria: December 15, 2025
• First Posted (Actual): December 18, 2025

Study Record Updates

• Last Update Posted (Actual): April 13, 2026
• Last Update Submitted That Met QC Criteria: April 9, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: cesarean section; TAP block; ESP block
• Other Study ID Numbers: 6334/AO/25

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No