Comparison of ultrasound-guided transversalis fascia plane block and anterior quadratus lumborum block in patients undergoing caesarean delivery: a randomized study

Abstract

Background Cesarean section is becoming increasingly common. Well-managed postoperative analgesia improves patient comfort while encouraging early ambulation and breastfeeding. The analgesic efficacy of transversalis facial plane block (TFPB) vs. anterior quadratus lumborum block (QLB) was compared in this study. Methods We analyzed the data of 49 pregnant women (gestation, ≥ 37weeks; age, 18–45years) scheduled for elective cesarean delivery (CD) under general anesthesia. They were randomly divided into TFPB and anterior QLB groups. All blocks were administered bilaterally with 25mL of 0.25% bupivacaine under ultrasound guidance prior to extubation. Postoperative morphine consumption and numerical rating scale (NRS) pain scores (static and dynamic [during coughing]) were recorded at 1, 3, 6, 9, 12, 18, and 24h. Results There was no difference in postoperative morphine consumption between the groups at the third, sixth, and ninth hours, but the anterior QLB group consumed less morphine at the 12th, 18th, and 24th hours. Except for the first hour, resting and dynamic NRS scores were comparable between the groups. The first-hour resting and dynamic NRS scores were lower in the TFPB group (resting NRS, anterior QLB group, median [interquartile range], 2 [2–3] vs. TFPB group, 2 [0–2], p = 0.046; dynamic NRS, anterior QLB group, median [interquartile range], 3 [2–4] vs. TFPB group 2 [0–3], p = 0.001). Conclusions In patients undergoing CD, anterior QLB decreased morphine consumption in the late period (9–24h) compared to TFPB, while pain scores were similar between both groups. The reduction in morphine consumption was statistically significant, but not clinically significant.

Ultrasound-guided anterior quadratus lumborum block at the L2 level for postsurgical analgesia in patients undergoing laparoscopic gynaecological surgery: a single-centre, randomised, double-blinded trial at a university-affiliated hospital in China

“… 26 Bilgin et al compared transversalis fascia plane block and anterior QLB in patients undergoing caesarean delivery, and confirmed that anterior QLB significantly reduced postoperative visceral pain and opioid consumption. 27 The study by Jadon et al reported that anterior QLB prolonged the time to the first request for analgesics, reduced the dose of fentanyl, and effectively alleviated postoperative pain, however the analgesic effect of anterior QLB on visceral pain could not be verified, because the study did not differentiate between incisional pain and visceral pain, the analgesic effect of anterior QLB on visceral pain could not be confirmed. 28 Similarly, Dam et al also reported the anterior QLB significantly reduced postoperative opioid consumption.…”