COMFORT trial protocol: a triple-blind randomized controlled trial of surgeon-administered TAP block during complex cesarean delivery

The COMFORT Trial (Complex Obstetric Management with Focused Regional Transversus Abdominis Plane Block) is a randomized controlled trial evaluating postoperative pain management in complex cesarean delivery. Transversus abdominis plane (TAP) blocks are commonly performed using local anesthetics such as bupivacaine and have been shown to reduce postoperative opioid consumption and improve pain control. When administered intraoperatively, TAP blocks may provide early and prolonged analgesia, potentially reducing opioid requirements and improving postoperative recovery. However, most studies evaluating TAP blocks in obstetrics have focused on routine Pfannenstiel cesarean deliveries. Limited data exist regarding their effectiveness in more complex obstetric surgeries, such as cesarean deliveries complicated by dense adhesions or other operative challenges. Optimizing postoperative pain management while minimizing opioid exposure remains an important priority in obstetric care. Despite the widespread use of TAP blocks, the role of intraoperative bupivacaine TAP block placement in complex obstetric surgery remains underexplored. This triple-blind randomized controlled trial aims to evaluate whether intraoperative TAP block placement with bupivacaine during complex cesarean deliveries reduces cumulative postoperative opioid consumption at 24 hours and 48 hours after surgery, expressed as morphine milligram equivalents, and improves postoperative analgesia.Clinical trial registration www.clinicaltrials.gov identifier is NCT06925152