Ultrasound-guided transversus abdominis plane block in cesarean delivery: a randomized trial of ketamine versus neostigmine as bupivacaine adjuvants.

Cesarean delivery (CD) stands as one of the most prevalent surgical procedures for childbirth. Ensuring effective pain management during and after CD is paramount to safeguarding the well-being and comfort of the mother. The transversus abdominis plane (TAP) block is a widely used technique for postoperative pain control. To enhance the duration and quality of analgesia provided by TAP blocks, adjuvants such as ketamine and neostigmine have been investigated. A prospective, double-blind randomized controlled study was adopted. Eighty patients scheduled for elective CS were randomized into two equal groups after receiving spinal anesthesia. Group K received postoperative TAP block with plain bupivacaine and ketamine and Group N received TAP block with bupivacaine and neostigmine. A significantly higher mean arterial blood pressure was observed at 18 h and 24 h in Group N compared to Group K. Comparing the postoperative visual analogue scale score, no significant differences were observed at 2 h, 4 h, and 6 h. At 12 h post-procedure, the mean VAS score was significantly higher for Group N compared to Group K. This trend continued at 18 and 24 h (p < 0.001). Both adjuvants effectively controlled postoperative pain, with stable intraoperative hemodynamics and high patient satisfaction levels. Ketamine demonstrated superior analgesic efficacy compared with neostigmine in cesarean delivery patients undergoing TAP blocks. An individualized treatment approach is needed to tailor the selection of adjuvants to optimize outcomes.