A triple-blinded randomized trial comparing spinal morphine with posterior quadratus lumborum block after cesarean section

Tamura, Takahiro; Yokota, Shuichi; Ando, Masahiko; Kubo, Yoko; Nishiwaki, Kimitoshi

doi:10.1016/j.ijoa.2019.06.008

Cited by 32 publications

(64 citation statements)

References 16 publications

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“…The proportion of patients with opioid sparing effects in our study suggests that the analgesic effect of QLB can last 6 to 10 hours, but not 24 or 48 hours as previously reported. 20 This result is similar to the ndings of Mieszkowski MM, et al 21 , Krohg A, et al 22 and Tamura T, et al 13,17 , all of whom found the bene t of QLB to be less than 24 hours. In 2018, Mieszkowski MM, et al reported the time from C-section until the rst dose of morphine to be approximately 10 hours in the QLB1 group.…”

Section: Discussionsupporting

confidence: 87%

“…Tamura T, et al and Ueshima et al also found minimal spread of local anesthetic into the paravertebral space and reported their concern that the volume of solution reaching the PVS was too small to exert a strong analgesic effect on visceral pain after cesarean delivery. 17,27 Limitations This study has some limitations. First, it was impossible to establish the sensory blockade of QLB after spinal block was performed.…”

Section: Discussionmentioning

confidence: 96%

“…Group IT morphine vs. 1.75 (95% CI: 0.75-2.75) in Group QLB. However, Tamura T, et al 17 reported that initial pain scores associated with non-morphine groups were signi cantly higher than those of IT morphine groups. Group QLB was terminated at the 2 nd interim analysis when inferior analgesia results were observed.…”

Section: Discussionmentioning

confidence: 96%

“…22 Tamura T, et al reported the duration of the sensory loss in their study did not exceed eight hours after the posterior QLB, even at the anterior axillary line. 13,17 From cadaveric and contrast studies, it is worthwhile to note that some of these studies could not demonstrate paravertebral spreading or even transient spreading. 10,23,24 This conduit was believed to facilitate upward spreading of local anesthetic into the paravertebral space to provide visceral analgesia coverage.…”

Section: Discussionmentioning

confidence: 99%

“…Speci cally, the addition of posterior QLB to a multimodal analgesic regimen including 0.1 mg IT morphine was associated with similar severity of postoperative pain. 17 Accordingly, we aimed to evaluate the analgesic effect of US-guided posterior QLB or QLB2 at the lumbar interfascial triangle 14,18 after cesarean delivery. The primary objective was to compare the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine 0.2 mg, with IT morphine and bilateral QLB, or with only bilateral QLB.…”

Section: Introductionmentioning

confidence: 99%

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Bilateral Posterior Quadratus Lumborum Block for Pain Relief after Cesarean Delivery: A Randomized Controlled Trial

Pangthipampai

Dejarkom

Poolsuppasit

et al. 2020

Preprint

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Background: Achieving optimal abdominal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal morphine is the current standard but ultrasound guided quadratus lumborum block (US-QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine 0.2 mg, with IT morphine 0.2 mg and bilateral QLB, or only bilateral QLB.Methods: Parturients having elective cesarean delivery with a low transverse incision under spinal block were randomized to three groups. Subjects were allocated into IT morphine 0.2 mg with sham QLB (Group IT morphine), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml and adrenaline 1:250,000 in each side (Group IT morphine with QLB), or bilateral QLB with 0.25% bupivacaine 25 ml and adrenaline 1:250,000 in each side (Group QLB). A PCA pump was connected to each parturient after completion of the QLB or sham block. The first time to PCA morphine requirement when parturients experienced pain was recorded and compared.Results: Eighty parturients were included. Analysis of Group QLB was terminated early because Kaplan-Meier survival analysis showed the median pain-free period to be significantly shorter in Group QLB at the second interim analysis; [2.50 hours (95% CI: 1.04-3.96) in Group IT morphine vs. 7.75 (95% CI: 5.67-9.83) in Group IT morphine with QLB vs. 1.75 (95% CI: 0.75-2.75) in Group QLB (overall p<0.001)]. The median (min, max) amount of morphine required during 24 hours was 5.5 (0-25) in Group IT morphine vs. 5.0 (0-36) in Group IT morphine with QLB vs. 17.5 (1-40) mg in Group QLB (p<0.001). In the final analysis the median pain-free period was 2.50 hours (95%CI: 1.23-3.77) in Group IT morphine (n=27) and 8.02 (95%CI: 5.96-10.07) in Group IT morphine with QLB (n=28). (Gehan-Breslow p=0.027).Conclusion: US-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB may provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period.Trial registration: ClinicalTrials.gov no. NCT03199170 Date registered on June 22, 2017. Prospectively registered.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Bilateral Posterior Quadratus Lumborum Block for Pain Relief after Cesarean Delivery: A Randomized Controlled Trial

Pangthipampai

Dejarkom

Poolsuppasit

et al. 2020

Preprint

View full text Add to dashboard Cite

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The analgesic efficacy of quadratus lumborum block in caesarean delivery: a meta-analysis and trial sequential analysis

Singh¹,

Makkar

Borle

et al. 2020

J Anesth

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Quadratus lumborum block for postoperative analgesia: a systematic review and meta-analysis

Uppal

Retter

et al. 2020

Can J Anesth/J Can Anesth

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The goal of the present systematic review is to determine the efficacy of the quadratus lumborum block (QLB) in providing postoperative analgesia for abdominal wall and hip surgeries when compared with placebo or other analgesic techniques. Methods Electronic databases (Medline, Embase, Cochrane Central, and Scopus) were searched for keywords and controlled vocabulary terms related to QLB from their inception to November 2019. The included studies compared ultrasound-guided singleinjection QLB to placebo and other analgesic techniques in adult patients. Results Forty-two randomized-controlled trials provided the data for this systematic review. Eight studies were assessed as high risk of bias in at least one domain. The included studies had significant heterogeneity with regard to the type of surgery, comparator groups, and outcomes measured; therefore, a limited quantitative analysis was undertaken for the comparison of QLB vs no block or placebo in patients undergoing Cesarean delivery only. For Cesarean delivery, the QLB reduced the opioid use by

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A triple-blinded randomized trial comparing spinal morphine with posterior quadratus lumborum block after cesarean section

Cited by 32 publications

References 16 publications

Bilateral Posterior Quadratus Lumborum Block for Pain Relief after Cesarean Delivery: A Randomized Controlled Trial

Bilateral Posterior Quadratus Lumborum Block for Pain Relief after Cesarean Delivery: A Randomized Controlled Trial

The analgesic efficacy of quadratus lumborum block in caesarean delivery: a meta-analysis and trial sequential analysis

Quadratus lumborum block for postoperative analgesia: a systematic review and meta-analysis

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