Comparison Between Erector Spinae Plane Block vs Transversus Abdominis Plane Block for Postoperative Analgesia in Cesarean Section

Erector Spinae Plane Block Versus Transversus Abdominis Plane Block For Postoperative Analgesia In Cesarean Section: Comparative Randomized Prospective Study

This study is a prospective randomized controlled trial designed to compare the effectiveness of the erector spinae plane (ESP) block versus the transversus abdominis plane (TAP) block for postoperative analgesia in patients undergoing cesarean section under spinal anesthesia. Sixty patients will be randomly allocated into two equal groups to receive either ESP or TAP block after surgery.

The primary outcome of the study is the assessment of postoperative pain using the Numeric Rating Scale (NRS) over the first 24 hours. Secondary outcomes include total morphine consumption, time to first request for rescue analgesia, patient satisfaction, incidence of complications, and hemodynamic stability.

All patients will receive standardized spinal anesthesia followed by the assigned block using a combination of bupivacaine and lidocaine under ultrasound guidance. Postoperatively, a multimodal analgesic regimen will be applied, including regular paracetamol and rescue analgesia with ketorolac or morphine based on pain scores.

The rationale of the study is based on the limitation of the TAP block in providing only somatic analgesia, whereas the ESP block may offer both somatic and visceral pain control due to its wider spread. Therefore, the study aims to determine whether ESP block provides superior postoperative analgesia and reduces opioid requirements compared to TAP block after cesarean delivery.

Study Overview

• Status: Not yet recruiting
• Conditions: Regional Block for Postoperative Analgesia in Cesarean Section
• Intervention / Treatment: Procedure: Erector Spinae Plane Block For Postoperative Analgesia In Cesarean Section; Procedure: Transversus Abdominis Plane Block For Postoperative Analgesia In Cesarean Section

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Mohamed ali Elyamany, resident; Phone Number: 01061646235; Email: aboelyamany@gmail.com

Study Locations

• Egypt
  • Sohag, Egypt
    • Sohag faculty of medicine
    • Contact: mohamed elyamany, resident; Phone Number: 01061646235; Email: aboelyamany@gmail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Age from 18 to 40 years old.

  • Pregnant women.
  • Scheduled for lower-segment cesarean section.
  • American Society of Anesthesiologists (ASA) physical status I-II.
  • Singleton pregnancy at ≥37 weeks' gestation.

Exclusion Criteria:

• • Contraindications to regional blocks or local anesthetics.

  • History of chronic analgesic use or opioid dependency.
  • Coagulopathy or anticoagulant therapy.
  • Local infection at the injection site.
  • Allergy to study medications.
  • Patient refusal.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: ESPB group; patients included in this group will receive the erector spinae plane block.	Procedure: Erector Spinae Plane Block For Postoperative Analgesia In Cesarean Section; For the ESP block, patients will be placed in the right lateral decubitus position, and the T9 transverse process will be identified using a high-frequency linear ultrasound probe positioned 2-3 cm lateral to the midline in a parasagittal orientation. After skin sterilization, a 21-gauge echogenic block needle will be advanced in-plane cranio-caudally until contact with the transverse process is achieved. Hydrodissection with sterile saline will be performed to confirm correct fascial plane placement beneath the erector spinae muscle. A total of 20 mL local anesthetic mixture will be administered on each side, consisting of 10 mL bupivacaine 0.25%- and 10-mL lidocaine 0.5%, ensuring that the maximum safe dose is not exceeded. Correct spread will be confirmed under ultrasound by observing separation of the fascial layers.
Active Comparator: TAP group; patients included in this group will receive the transversus abdominis plane block.	Procedure: Transversus Abdominis Plane Block For Postoperative Analgesia In Cesarean Section; For the TAP block, patients will be placed supine, and the posterior approach will be used with the probe placed midway between the subcostal margin and the iliac crest in the anterior axillary line. The fascial plane between the internal oblique and transversus abdominis muscles will be visualized until it tapers toward the quadratus lumborum. A 21-gauge echogenic needle will be introduced in-plane from anterior to posterior, and hydrodissection with sterile saline will be performed to confirm the correct plane. A total of 20 mL local anesthetic mixture will be administered per side, composed of 10 mL bupivacaine 0.25%- and 10-mL lidocaine 0.5%, with care taken to remain within safe dosage limits.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative pain scores assessment using the Numeric Rating Scale (NRS).	Postoperative pain scores will be assessed using the Numeric Rating Scale (NRS) at 2, 4, 6, 12 and 24 hours only. Pain scores will be evaluated both at rest and during movement.Patients will be informed about Numerical Rating Scale (NRS) and asked to circle the number between 0 and 10, Zero means no pain and ten means the worst pain].	Postoperative pain scores will be assessed using the Numeric Rating Scale (NRS) at 2, 4, 6, 12 and 24 hours only.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total morphine consumption	• Total morphine consumption in the first 24 hours postoperatively.	the first 24 hours postoperatively.
Time to first request for rescue analgesia.		during the first 24 postoperative hours.
Patient satisfaction scores	Degree of patient satisfaction will be assessed on a 5-point likert scale Patient satisfaction (1, extremely dissatisfied; 2, unsatisfied; 3, neutral; 4, satisfied ; 5, extremely satisfied) (10).	at 24 hours.
Incidence of block-related complications	Adverse events: local anesthetic systemic toxicity (LAST), bradycardia, hypotension, nausea, vomiting, respiratory depression or any other complication.	first 24 hours postoperatively.

Collaborators and Investigators

• Sponsor: Sohag University

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): May 1, 2026
• Study Completion (Estimated): March 1, 2027

Study Registration Dates

• First Submitted: April 30, 2026
• First Submitted That Met QC Criteria: May 11, 2026
• First Posted (Actual): May 13, 2026

Study Record Updates

• Last Update Posted (Actual): May 13, 2026
• Last Update Submitted That Met QC Criteria: May 11, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Surgical Procedures, Operative; Delivery, Obstetric; Obstetric Surgical Procedures; Cesarean Section
• Other Study ID Numbers: soh-Med-26-3-10MS

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