Comparative efficacy of transversalis fascia plane block and transversus abdominis plane block for postoperative pain management following cesarean delivery: a systematic review and meta-analysis

Background: Cesarean section is among the most widely performed obstetric procedures globally and is frequently complicated by moderate to severe postoperative pain. The transversalis fascia plane block (TFPB) and transversus abdominis plane block (TAPB) are regional anesthetic techniques commonly used for post-cesarean analgesia. This study aimed to compare the analgesic effectiveness of TFPB versus TAPB in women undergoing cesarean section under spinal anesthesia. Methods: PubMed, Scopus, Cochrane Library, and Web of Science were searched from inception through December 2025 for randomized controlled trials (RCTs) comparing TFPB with TAPB in women undergoing cesarean delivery. The primary outcome was pain scores during movement assessed by the numeric rating scale (NRS). Secondary outcomes included cumulative 24-h opioid consumption, requirement for rescue analgesia, time to first request for postoperative analgesia, and patient satisfaction. Results: Six RCTs encompassing 491 participants met the inclusion criteria. Compared with TAPB, TFPB was associated with lower NRS pain scores during movement at 6, 12, and 24 h postoperatively. TFPB was further associated with lower total opioid requirements, a reduced likelihood of needing rescue analgesia, a prolonged interval to the first analgesic request, and higher patient-reported satisfaction scores. Conclusions: Among women undergoing cesarean section under spinal anesthesia, TFPB appears associated with better short-term analgesic outcomes compared with TAPB, reflected by lower pain scores, decreased opioid requirements, reduced rescue analgesia use, and higher patient satisfaction. However, substantial heterogeneity and limited sample size warrant cautious interpretation. Larger, adequately powered, and methodologically standardized RCTs are warranted to confirm these findings.