• Sina Grape, Kyle Robert Kirkham, and Eric Albrecht.
• From the Department of Anaesthesia, Valais Hospital, Sion (SG), University of Lausanne, Lausanne, Switzerland (SG), Department of Anaesthesia, Toronto Western Hospital, University of Toronto, Toronto, Canada (KRK) and Department of Anaesthesia, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland (EA).
• Eur J Anaesthesiol. 2022 Mar 1; 39 (3): 244251244-251.

BackgroundTransversus abdominis plane (TAP) block and local anaesthetic wound infiltration are used to relieve pain after caesarean section.ObjectivesTo determine whether TAP block or local anaesthetic wound infiltration is the better analgesic option after caesarean section.DesignSystematic review and meta-analysis with trial sequential analysis.Data SourcesMEDLINE, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Science up to June 2020.Eligibility CriteriaWe retrieved randomised controlled trials comparing TAP block with wound infiltration after caesarean section. Primary outcome was pain score during rest (analogue scale, 0 to 10) at 2 h postoperatively, analysed according to the TAP block technique (ultrasound-guided/landmark-guided), anaesthetic strategy (spinal/general), intrathecal fentanyl (yes/no) and multimodal analgesia (yes/no). Secondary pain-related outcomes included pain scores during rest at 12 and 24 h, and total intravenous morphine consumption at 2, 12 and 24 h. We sought rates of block complications, including postoperative infection, haematoma, visceral injury and local anaesthetic systemic toxicity.ResultsSeven trials, totalling 475 patients, were identified. There was no difference in pain score during rest at 2 h between groups. Subgroup analyses revealed no differences related to TAP block technique (P = 0.64), anaesthetic strategy (P = 0.53), administration of intrathecal fentanyl (P = 0.59) or presence of multimodal analgesia (P = 0.57). Pain score during rest at 12 h and intravenous morphine consumption at 2 and 12 h were identical in both groups. Data were insufficient to compare block complications. Overall quality of evidence was moderate.ConclusionThere is moderate level evidence that TAP block and wound infiltration provide similar postoperative analgesia after caesarean section.Trial Registry NumberPROSPERO CRD42020208046.Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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