Transversus abdominis plane block with liposomal bupivacaine versus standard bupivacaine for postoperative analgesia in elective cesarean section: a systematic review and meta-analysis

Background Transversus abdominis plane (TAP) block with bupivacaine is commonly used for analgesia after cesarean deliveries. Liposomal bupivacaine has been incorporated into TAP blocks to potentially prolong analgesic effects and reduce opioid use. However, its effectiveness for elective cesarean section remains uncertain. Methods This review was registered on PROSPERO (CRD420251046460). We systematically searched MEDLINE, EMBASE, and the Cochrane Library for studies comparing TAP block with liposomal bupivacaine plus conventional bupivacaine vs. conventional bupivacaine alone in women undergoing elective cesarean delivery. Meta-analyses were performed using random-effects models. Heterogeneity was assessed with I 2 statistics and Cochran's Q test. Results Three randomized controlled trials (meta-analysis) and one retrospective study (qualitative synthesis) were included, comprising 695 patients. Of these, 357 (51.4%) received TAP block with liposomal bupivacaine. Its use was associated with significantly decreased opioid consumption at 24 h (mean difference −0.76 mg IV morphine equivalents; 95% CI −1.46 to −0.07; p = 0.03; I 2 = 20%). However, the absolute 24-hour reduction was small and well below the accepted minimal clinically important difference (MCID), suggesting no clinically meaningful opioid-sparing benefit. No significant differences were found in opioid consumption at 48 h, time to first rescue analgesia, or the incidence of nausea, dizziness, or serious adverse events. Conclusion In this meta-analysis, adding liposomal bupivacaine to TAP block resulted in a statistically significant but clinically trivial reduction in 24-hour opioid consumption (below accepted MCID thresholds), with no significant differences at 48 h. Time to first rescue analgesia and adverse events were similar between groups.