Date of Award

8-14-2026

Document Type

Capstone

Degree Name

Doctor of Nursing Practice (DNP)

School Name

Donna and Allan Lansing School of Nursing and Health Sciences

Department

Nursing

Major Advisor

Carly Mitchell

Abstract

Postoperative pain hinders cesarean delivery recovery and overall patient experience. Although spinal anesthesia with intrathecal opioids remains the standard of practice, associated side effects and concerns regarding opioid exposure highlight the need for effective opioid-sparing strategies. Anesthesia providers play a critical role in advancing postoperative pain management through evidence-based protocol development, provider education, and interdisciplinary collaboration to optimize maternal outcomes. The transversus abdominis plane (TAP) block provides somatic analgesia to the anterior abdominal wall by targeting the thoracolumbar nerves (T6–L1) and has increasingly been incorporated into multimodal postoperative pain management strategies for abdominal surgery. Nevertheless, a gap remains in obstetric anesthesia because of variability in practice, particularly regarding use with intrathecal morphine versus within opioid-sparing Enhanced Recovery After Surgery (ERAS) pathways. This scholarly project examined the effectiveness of ultrasound-guided bilateral TAP block as an adjunct to spinal anesthesia for improving postoperative recovery following primary cesarean delivery. A focused review of randomized controlled trials, systematic reviews, meta-analyses, and clinical implementation studies representing more than 2,000 patients evaluated outcomes including postoperative pain scores, opioid consumption, postoperative nausea and vomiting, and patient satisfaction. Evidence consistently demonstrated that TAP blocks significantly reduce early postoperative pain and opioid requirements, with reported reductions in opioid consumption of approximately 12.7 mg morphine equivalents within 24 hours. TAP blocks provided the greatest benefit within opioid-sparing or ERAS pathways when intrathecal morphine was omitted. These findings support standardizing TAP blocks in multimodal cesarean care and guided the creation of an implementation toolkit for obstetric practice.

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