The impact of bilateral transversus abdominis plane block on early wound healing after cesarean delivery: a single-center randomized trial

Cesarean delivery is associated with significant postoperative pain, which may impair wound healing. Transversus abdominis plane (TAP) block provides effective analgesia. Dexmedetomidine may enhance this effect. However, its impact on post-cesarean wound healing remains underexplored. This study evaluated the effect of TAP block on early post-cesarean wound healing. In this prospective, randomized, assessor-blinded study, 107 eligible women scheduled for elective cesarean delivery were assigned to one of three groups, and 105 were included in the final analysis. Group SA received standard postoperative analgesia. Group L additionally received a bilateral ultrasound-guided TAP block with 20 ml of 0.25% levobupivacaine on each side. Group D received the same TAP block with the addition of dexmedetomidine 0.5 µg/kg per side. The primary outcome was wound healing evaluated with the REEDA scale. Secondary outcomes included postoperative pain scores at rest and during movement. Postoperative numerical rating scale scores at rest and during movement were significantly lower in both TAP block groups compared to the Group SA up to 24 h. Group D showed superior analgesia over Group L at early time points (four to 12 h). Total REEDA scores were significantly higher in the Group SA compared to the Groups L (OR = 4.75, 95% CI = [1.57, 14.41], p = 0.003) and D (OR = 6.34, 95% CI = [2.03, 19.77], p < 0.001), with no significant difference between Groups L and D ( p = 0.820). TAP block with levobupivacaine, with or without dexmedetomidine, provides superior postoperative pain control and is associated with more favorable early wound status, as reflected by lower REEDA scores on the third postoperative day, compared with standard analgesia after cesarean delivery. The study was registered at ClinicalTrials.gov, NCT05840406. April 14, 2023. Unique Protocol Id 00306/22 − 03/007. URL: https://clinicaltrials.gov/study/NCT05840406 .