REVIEW article
Front. Anesthesiol.
Sec. Perioperative Medicine
This article is part of the Research TopicPerioperative Optimization and Perioperative Medicine: Optimizing Outcomes and Safety across Surgical CareView all 13 articles
Transversus abdominis plane (TAP) block with liposomal bupivacaine versus standard bupivacaine for postoperative analgesia in elective cesarean section: a systematic review and meta-analysis
Provisionally accepted
Matheus Requena Escobar1*
Sara Amaral2Letícia Oku1Vitor Felippe3
Carlos Darcy Alves Bersot4
Thomas Rolf Erdmann5- 1Centro Universitario Lusíada, Santos, São Paulo, Brazil
- 2Duke University Hospital, Durham, United States
- 3Instituto Nacional de Cancer, Rio de Janeiro, Brazil
- 4Universidade Federal de Sao Paulo, São Paulo, Brazil
- 5Universidade Federal de Santa Catarina, Florianópolis, Brazil
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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 versus conventional bupivacaine alone in women undergoing elective cesarean delivery. Meta-analyses were performed using random-effects models. Heterogeneity was assessed with I² 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 hours (mean difference −0.76 mg IV morphine equivalents; 95% CI −1.46 to −0.07; p = 0.03; I² = 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 hours, 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 hours. Time to first rescue analgesia and adverse events were similar between groups. Keywords: Analgesia, Bupivacaine, Cesarean Section, Meta-Analysis, Nerve Block, Pain Management
Keywords: Analgesia, Bupivacaine, Cesarean Section, Meta-analysis, Nerve Block, Pain Management
Received: 24 Oct 2025; Accepted: 11 Feb 2026.
Copyright: © 2026 Requena Escobar, Amaral, Oku, Felippe, Alves Bersot and Erdmann. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Matheus Requena Escobar
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