The effectiveness of M-TAPA on pain management and quality of recovery after cesarean section: A prospective randomized- controlled study

Objective: Moderate-to-severe pain is a common complaint after cesarean section (C/S) and may adversely affect the recovery and well-being of both the mother and the newborn. This prospective randomized controlled trial aimed to determine whether ultrasound-guided modified thoracoabdominal nerve block via the perichondral approach (M-TAPA) improves postoperative analgesia and quality of recovery after cesarean section.Methods: This single-center study included pregnant women scheduled for elective cesarean section, beyond the 37th week of gestation, with American Society of Anesthesiologists (ASA) physical status II. Participants were randomly allocated to the M-TAPA group or the control group. Postoperative pain was assessed using the numeric rating scale (NRS), and quality of recovery was assessed using the 15-item Quality of Recovery Scale (QoR-15). Primary and secondary outcomes were statistically compared between groups.Results: Patients who received M-TAPA showed significantly lower pain scores than the control group at rest and with movement at postoperative hours 2, 4, 8, and 16 (p < 0.05); however, NRS values at postoperative hour 24 were similar between groups. Opioid consumption was similarly reduced, and QoR-15 scores were higher in the M-TAPA arm compared with the control group (p = 0.001).Conclusion: M-TAPA provides effective analgesic management after cesarean section. M-TAPA is important for supporting recovery and reducing opioid requirements, thereby improving outcomes in women undergoing cesarean section.Trial Registration: The study was registered at ClinicalTrials.gov (ID: NCT06078475).