Volume 29, Issue 165, November 2025

Comparison of the efficacy of TAP block, QLB, and subarachnoid opioid blockade in the treatment of postoperative pain after cesarean section, with particular emphasis on the well-being and postpartum mobilization of patients

Stawarz-Kobyliński Sergiusz^1♦, Bojarzyńska Gracja², Pawul Weronika², Woźnicka Weronika², Ćwiek Zuzanna², Mińkowska Aleksandra², Lucima Łukasz², Barański Michał², Wydra Klaudia², Kondracka Monika³

¹Medical University of Białystok, Białystok, Poland
²Medical University of Lublin, Lublin, Poland
³Prague Hospital of Lord's Transfiguration, Warsaw, Poland

^♦Corresponding author
Stawarz-Kobyliński S. Medical University of Białystok ul. Jana Kilińskiego 1, 15-089 Białystok, Poland

ABSTRACT

Having pain control for postoperative pain after cesarean delivery is important as it improves recovery, mobility, and early bonding with the newborn. Current Enhanced Recovery After Cesarean (ERAC) protocols recommend multimodal, opioid-sparing analgesia to enhance outcomes and minimize adverse effects. This narrative review summarises evidence from randomized trials, meta-analyses and systematic reviews on three analgesic techniques: the Transversus Abdominis Plane (TAP) block, Quadratus Lumborum Block (QLB) and intrathecal morphine (ITM). Key endpoints reported were resting and dynamic pain scores, time to first rescue analgesia, postoperative opioid requirements, side effect occurrence, patient mobilization time and satisfaction with the process. QLB is more efficient in broader, longer-lasting analgesia than TAP block, and dynamic pain control is superior, facilitating earlier recognition and elimination of additional analgesics. This translates into more comfort for patients and faster mobilization. QLB offers similar efficacy in the early phases of pain control relative to intrathecal morphine with significantly fewer opioid adverse events, such as pruritus and postoperative nausea and vomiting. TAP block is still an effective, safe and technically easy method particularly for somatic pain, although its duration is limited to approximately 6–12 hours. Intrathecal morphine continues to be an effective analgesic method for up to 24 hours of visceral and somatic analgesia but requires close monitoring due to its potential side effects. Hence, regional approaches especially QLB should be considered as crucial factors in multimodal analgesia after cesarean section, while opioids should be prescribed in the lowest effective dose with adequate prophylaxis and monitoring.

Keywords: Transversus abdominis plane block (TAP block); Quadratus lumborum block (QLB); Intrathecal opioids; Cesarean section; Postoperative pain; Maternal well-being

Medical Science, 2025, 29, e217ms3730

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DOI: https://doi.org/10.54905/disssi.v29i165.e217ms3730

Published: 27 November 2025