Transversus Abdominis Plane Block with Liposomal Bupivacaine versus Ropivacaine for Postoperative Cesarean Analgesia: A Randomized Controlled Trial.

BACKGROUND: Effective postoperative analgesia is critical for enhanced recovery after cesarean delivery (CD). Chinese liposomal bupivacaine (LB), a multivesicular long-acting local anesthetic, may provide prolonged analgesia when used in transversus abdominis plane (TAP) blocks, but data in CD remain limited. METHODS: This prospective randomized controlled trial, conducted at a single center and utilizing a design with blinded outcome assessment, involved patients who were scheduled to undergo elective CD under spinal anesthesia. Participants were randomly assigned in a 1:1 fashion to either receive bilateral TAP blocks with LB 266 mg or with ropivacaine (RP) 150 mg. All individuals in the study were given standardized multimodal analgesia that included patient-controlled intravenous analgesia based on sufentanil. The main outcome measured was the pain scores assessed using a visual analog scale (VAS) at rest and movement at 24 hours following surgery. Secondary outcomes encompassed the VAS at rest and movement at 48 and 72 hours, the consumption of opioids, activations of PCIA, usage of rescue analgesics, functional recovery, duration of hospital stay, levels of patient satisfaction, and any adverse events (AEs) that occurred. RESULTS: A total of 82 patients participated in the study. There was no significant between-group difference in movement VAS scores at 24 hours. However, movement VAS scores were significantly lower in the LB group at 48 and 72 hours (P<0.05). Additionally, the cumulative opioid usage over 72 hours was significantly decreased in the LB group (P = 0.008). The overall occurrence of AEs was also lower in the LB group (4.9% vs 19.5%, P = 0.043), with no serious treatment-related AEs observed. CONCLUSION: In this randomized controlled trial, LB did not significantly reduce pain scores at the predefined 24-hour primary endpoint compared with RP. Lower movement pain scores at 48 and 72 hours and a modest reduction in postoperative opioids consumption were observed as secondary findings. TRIAL REGISTRATION: ChiCTR2400088013.