Evidence map›Paper›PMID 40074621›Full record

SynthesisBritish journal of anaesthesia2025

The analgesic effects of novel fascial plane blocks compared with intrathecal morphine after Caesarean delivery: a systematic review and meta-analysis.

Nasir Hussain, Richard Brull, Lauren Thaete, Samantha Fuller, Ryan S D'Souza, Yasmeen Mankinen-Abdallah, Michael K Essandoh, Tristan E Weaver, Faraj W Abdallah

Registry-linked trialAbstract readComparative StudyMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in British journal of anaesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07137208 (Bilevel Erector Spinae Plane Block Versus Transversus Abdominis Plane Block for Analgesia After Cesarean Delivery Under Spinal Anesthesia), which is not on this map. Cited by 15 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07137208 nacompletednot on this map

Bilevel Erector Spinae Plane Block Versus Transversus Abdominis Plane Block for Analgesia After Cesarean Delivery Under Spinal Anesthesia: A Randomized Controlled Trial

TypeinterventionalSponsorMansoura UniversityRan2025 to 2026Enrolled90ConditionsCesarean Section WoundArmsESP block, TAP Block, Bupivacaine injection
3 · Its place in the literature

Who cites it

15 citing papers in PubMed, 1 synthesis or guideline pooled it.

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  5. Erector spinae plane block.BJA education · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Nasir HussainDepartment of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Richard BrullDepartment of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
Lauren ThaeteDepartment of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Samantha FullerDepartment of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Ryan S D'SouzaMayo Clinic Department of Anesthesiology and Perioperative Medicine, Rochester, MN, USA.
Yasmeen Mankinen-AbdallahFaculty of Arts and Sciences, University of Toronto, Toronto, ON, Canada.
Michael K EssandohDepartment of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Tristan E WeaverDepartment of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Faraj W AbdallahDepartment of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Department of Anesthesia, and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. Electronic address: FAbdallah@toh.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIntrathecal morphine is the mainstay for post-Caesarean multimodal analgesia but is associated with important side-effects. Novel ultrasound-guided abdominal wall fascial plane blocks are proposed as intrathecal morphine alternatives, but evidence of effectiveness is conflicting. We compared the analgesic effects of fascial plane blocks with those of intrathecal morphine after Caesarean delivery.

methodsWe sought trials comparing the analgesic effects of intrathecal morphine with quadratus lumborum (QL), transversus abdominus plane (TAP), or erector spinae plane (ESP) blocks after Caesarean delivery. The primary outcome was rest pain intensity at 6 h on a visual analogue scale (VAS) ranging from 0 to 10 cm, with 10 cm indicating severe pain. Secondary outcomes included pain at 12 and 24 h; cumulative 24-h opioid consumption in milligrams of oral morphine; times to first analgesic request, ambulation, and breast feeding in hours; lengths of recovery room and hospital stay in hours; incidence of opioid-related side-effects; and block-related complications.

resultsEighteen trials (1525 subjects) were included. TAP block was evaluated in 11 studies, QL block in five, and ESP block in two. Intrathecal morphine was superior to TAP block for pain at 6 and 12 h, with mean differences (Hartung-Knapp-Sidik-Jonkman [HKSJ] 95% confidence interval [CI]) of 1.21 cm (0.42-2.00) (P=0.01, I

conclusionsQuadratus lumborum block, rather than erector spinae or transversus abdominus plane blocks, may be a better intrathecal morphine alternative owing to similar post-Caesarean analgesic effects and reduced opioid-related side-effects. SYSTEMATIC REVIEW PROTOCOL: CRD42024543371.

Indexed as

Analgesia, ObstetricalAnalgesics, OpioidCesarean SectionMorphineNerve BlockPostoperative PainFemaleHumansInjections, SpinalPregnancyUltrasonography, InterventionalAnalgesics, OpioidMorphineanalgesiaCaesarean deliveryerector spinae blockfascial plane blocksquadratus lumborum blocktransversus abdominus plane block

Identifiers

PMID40074621
PMCPMC12106898

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.