Evaluation of the effectiveness of the Quadratus Lumborum Block type I using ropivacaine in postoperative analgesia after a cesarean section — a controlled clinical study

Abstract

Objectives: Quadratus Lumborum Block in contrast to Transversus Abdominis Plane Block contains a unique component which not only stops somatic pain but also inhibits visceral pain by spreading the local anesthetic to the paravertebral space. This study was designed to determine whether performing the Quadratus Lumborum Block type I in patients undergoing cesarean section would be associated with both decreased morphine consumption and decreased pain levels in the postoperative 48-hour period. Material and methods:Sixty patients undergoing caesarean section under spinal anesthesia were randomly and equally assigned to one or other of two groups: QLB I (who received Bilateral Quadratus Lumborum Block type I with the use of 24 mL 0.375% ropivacaine per side) or a Control group. In both groups, on-demand morphine analgesia was administered postoperatively within the first 48 hours. The following were measured: the morphine consumption; the time elapsed from the C-section until the first dose of morphine; and the levels of pain intensity among patients in rest (numeral pain rating scale).Results: There were no statistically significant demographic data differences between the QLB I and Control groups. The following significant differences were observed in the 48-hour postoperative period: morphine consumption was higher in the Control group (p = 0.000); the time elapsed from the C-section until the first dose of morphine was longer in QLB I group (p < 0.05); and the median of the pain numeric rating scale was higher in the Control group (p < 0.05). Conclusions:Quadratus Lumborum Block type I significantly reduces morphine consumption and pain levels up to 48 hours postoperatively.

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

“…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.…”

“…The cumulative morphine use (mg) and demands between groups are shown in Table 6. The proportion of patients without morphine requirement at 6, 8, 10, and 12 hours postoperatively in Group IT morphine vs. Group IT morphine with QLB was 10 (37%) vs. 21 No patients in Group QLB experienced pruritus compared with other two groups (55% in Group IT morphine and 16.7% in Group IT morphine with QLB) at the 2 nd interim analysis (Table 1). However, the number of parturients who experienced postoperative nausea and vomiting was comparable among the study groups.…”

“…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. 21 A 2018 study by Krohg A, et al did not identify any clinically relevant opioid-sparing effect attributable to QLB during the 24 to 48-hour period. 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.…”

Ultrasound-guided bilateral quadratus lumborum block vs. intrathecal morphine for postoperative analgesia after cesarean section: a randomized controlled trial

“…Acute pain after CS has both somatic and visceral components that result from surgical cutting of the abdominal wall and uterus. TAP block, as a part of a multimodal analgesic regimen after CS, provides effective analgesia for somatic pain at the abdominal wall [9].…”

“…In 2015, the QLB technique was modified by shifting the injection point from the anterolateral border of the quadratus lumborum to the posterior border (QLB II) [10]. QLB inhibits the dual pain components (somatic and visceral) as a result of local anesthetic spreading to the paravertebral space [9,10]. The analgesic efficacy of QLB II and its superiority over TAP block after CS were proved by Blanco [10,11].…”