Ultrasound-guided transversalis fascia plane block for postoperative analgesia: A systematic review and meta-analysis

Ultrasound-guided transversalis fascia plane block (TFPB) has been used for providing postoperative analgesia after various lower abdominal surgeries like iliac crest bone harvesting, inguinal hernia repair, caesarean section and appendicectomy. After registering the protocol in PROSPERO, various databases like PubMed/Medline, Ovid, CENTRAL and clinicaltrials.gov were searched for randomized controlled trials and observational, comparative studies till October 2022. The risk of bias (RoB-2) scale was used to assess the quality of evidence. The database searched identified 149 articles. Out of these, 8 studies were identified for qualitative analysis and 3 studies were TFPB was compared to control in patients undergoing caesarean section were selected for quantitative analysis. At 12 hours, pain scores were significantly less in TFPB group when compared to control on movement with no heterogeneity. At other times, the pain scores were comparable. 24-hr opioid consumption was significantly less in TFPB group when compared to control with significant heterogeneity. Time to rescue analgesia was significantly less in TFPB group when compared to control with significant heterogeneity. Number of patients requiring rescue analgesia were significantly less in TFPB group when compared to control with no heterogeneity. Postoperative nausea/vomiting (PONV) was significantly less in TFPB group when compared to control with minimal heterogeneity. In conclusion, TFPB is a safe block which provides opioid-sparing postoperative analgesia and a delayed time to rescue analgesia with no significant difference in pain scores and lesser PONV postoperatively when compared to control in patients undergoing caesarean section.