Comparison of analgesic modalities after cesarean section: a network meta-analysis and systematic review.
Summary
Across 110 RCTs (n=8,871) comparing 17 techniques, intrathecal and epidural morphine provided the strongest analgesia after cesarean delivery. Quadratus lumborum and transversus abdominis plane approaches reduced postoperative opioid requirements, while transversalis fascia plane favored non-opioid-supplemented strategies. Lateral TAP and anterior/posterior QLB reduced complications; IM plus Petit TAP yielded highest satisfaction.
Key Findings
- Intrathecal and epidural morphine ranked highest for analgesic efficacy after cesarean delivery.
- Quadratus lumborum and transversus abdominis plane blocks reduced postoperative opioid requirements.
- Lateral TAP and anterior/posterior QLB reduced postoperative complications; IM plus Petit TAP maximized satisfaction.
Clinical Implications
Default to intrathecal/epidural morphine for strongest analgesia where feasible; consider QLB (especially QLB III) or TAP to reduce opioid needs and complications. For non-opioid supplementation strategies, transversalis fascia plane is a prioritized option.
Why It Matters
This comprehensive synthesis clarifies relative performance of widely used regional and neuraxial techniques, directly informing opioid-sparing and satisfaction-focused post-cesarean analgesia pathways.
Limitations
- Heterogeneity across trials in techniques, dosing, and outcome timepoints may affect consistency
- PRISMA adherence and assessment of transitivity/inconsistency not fully detailed in the abstract
Future Directions
Prospective, standardized RCTs comparing leading strategies (IM, QLB variants, TAP, TFP) with uniform outcomes, safety profiles (pruritus, PONV), and breastfeeding metrics.
Study Information
- Study Type
- Meta-analysis
- Research Domain
- Treatment
- Evidence Level
- I - Systematic review and network meta-analysis of randomized controlled trials
- Study Design
- OTHER