Effect of Bilateral Ultrasound-Guided TAP Block on Quality of Recovery in Cesarean Delivery Patients Receiving Intrathecal Morphine
Trial Parameters
Brief Summary
This prospective, assessor-blinded observational cohort study will investigate the effect of adding bilateral ultrasound-guided transversus abdominis plane (TAP) block to standard intrathecal morphine (ITM) analgesia on the quality of recovery in women undergoing elective cesarean delivery under spinal anesthesia. All participants will receive ITM as part of routine spinal anesthesia. The TAP group will receive an additional bilateral ultrasound-guided TAP block at the end of surgery, while the control group will not receive any additional block. Both groups will receive standardized postoperative analgesia with intravenous patient-controlled analgesia (IV PCA). The primary outcome is the quality of recovery at 24 hours postoperatively, measured using the validated Obstetric Quality of Recovery-10 (ObsQoR-10) questionnaire. Secondary outcomes include Numerical Rating Scale (NRS) pain scores, time to first breastfeeding, time to mobilization, time to hospital discharge, and total opioid consumption in the first 24 hours after surgery. Outcome assessors will be blinded to group allocation. The study aims to determine whether TAP block enhances functional recovery, reduces pain, and decreases analgesic requirements when used alongside ITM in cesarean delivery patients.
Eligibility Criteria
Inclusion Criteria: * Female patients aged 18-45 years * Singleton pregnancy * ASA physical status II-III * Scheduled elective lower segment cesarean delivery under spinal anesthesia with intrathecal morphine (ITM) as standard care * Able to understand study procedures, provide written informed consent, and reliably use IV PCA * Able to complete ObsQoR-10-T assessments (with trained assistance if needed) Exclusion Criteria: * Contraindication to spinal anesthesia or TAP block (e.g., infection at injection site, coagulopathy, allergy to local anesthetics) * Chronic opioid use or opioid/alfa-2 agonist intolerance * Severe preeclampsia, HELLP syndrome, significant hepatic or renal impairment * Urgent or emergent cesarean section (Category 1) * Cognitive impairment or communication difficulty preventing accurate assessment * Prior major abdominal surgery (other than previous cesarean delivery) * Body mass index (BMI) \> 40 kg/m² * Major psychiatric illness (e.g., major depressive disorder,