Background: Effective postoperative pain management in cesarean delivery is crucial for patient recovery and satisfaction. This study aimed to evaluate the efficacy of transversus abdominis plane (TAP) block with levobupivacaine versus a combination of levobupivacaine with dexmedetomidine for postoperative analgesia in cesarean delivery.

Methods: In this double-blinded randomized control trial, 90 patients undergoing cesarean delivery under spinal anesthesia were divided into three groups: Group C (control), Group L (levobupivacaine), and Group LD (levobupivacaine with dexmedetomidine). The primary outcome was the time to the first request for rescue analgesia. Secondary outcomes included pain scores at rest and on movement, patient satisfaction, and the incidence of side effects.

Results: The time to first request for rescue analgesia was significantly longer in Group LD (600 minutes) compared to Group L (352.5 minutes) and Group C (90 minutes) (p<0.05). Pain scores at rest and on movement were lowest in Group LD at all time intervals, with significant differences observed when compared to both Group L and Group C (p<0.05). Patient satisfaction was highest in Group LD. The incidence of side effects such as nausea and pruritus was comparable across all groups.

Conclusion: The addition of dexmedetomidine to levobupivacaine in TAP blocks significantly enhances postoperative analgesia in cesarean delivery, with prolonged pain relief and higher patient satisfaction without increasing side effects. These findings support the use of dexmedetomidine as an adjunct in TAP blocks for improved pain management post-cesarean delivery.