Quadratus Lumborum and Transversus Abdominis Plane Blocks and Their Impact on Acute and Chronic Pain in Patients after Cesarean Section: A Randomized Controlled Study

Borys, Michał; Alexandra, Zamaro; Horeczy, Beata; Gęszka, Ewa; Janiak, Marek; Węgrzyn, Piotr; Czuczwar, Mirosław; Piwowarczyk, Paweł

doi:10.3390/ijerph18073500

Cited by 20 publications

(29 citation statements)

References 30 publications

(7 reference statements)

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“… 86 , 88 , 89 A recently published study revealed that QLB not only reduced acute pain scores (with similar efficacy to TAPB during the acute phase) but also reduced the severity of persistent postoperative pain months after CS (with better efficacy than TAPB during the chronic phase). 90 More RCTs are needed to confirm these findings. The durations of other local anesthetic techniques were similar.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Local Anesthetic Techniques for Postoperative Analgesia After Cesarean Section: A Bayesian Network Meta-Analysis of Randomized Controlled Trials

Wang¹,

Zhao²,

Song³

et al. 2021

JPR

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Objective Cesarean section (CS) is one of the most frequently performed major surgical interventions. Local anesthetic techniques, a universal component of perioperative multimodal analgesia, are reportedly effective in reducing pain scores and opioid requirements. However, the optimal local anesthetic technique for postoperative CS pain remains unclear. Methods Six databases were searched, and a Bayesian network meta-analysis was performed. The outcomes included cumulative morphine consumption and pain scores at four time points, time to first analgesic request, postoperative nausea and vomiting, pruritus, and sedation. Results Sixty-eight studies with 5039 pregnant women were included. Six local anesthetic techniques were involved, including transversus abdominis plane block (TAPB), ilioinguinal and iliohypogastric nerve block, quadratus lumborum blocks, transversalis fascia plane block, erector spinae block, and wound infiltration. Compared to inactive controls, TAPB reduced cumulative morphine consumption at 6, 12, 24, and 48 h, pain scores at 6, 12, and 24 h (with the exception of 24 h at rest), the risk of postoperative nausea and vomiting, and sedation. Compared with inactive controls, ilioinguinal and iliohypogastric nerve block reduced cumulative morphine consumption at 6 and 24 h and pain scores at 6, 12, and 24 h during movement. Compared with inactive controls, quadratus lumborum blocks reduced cumulative morphine consumption at 24 and 48 h and pain scores at 6 and 12 h and lengthened the time to first analgesic request. Compared with inactive controls, wound infiltration reduced cumulative morphine consumption at 12 and 24 h, pain scores at 12 and 24 h during movement, and risk of sedation. Compared with inactive controls, erector spinae block reduced pain scores at 6 and 12 h. Transversalis fascia plane block was found to have similar outcomes to inactive controls. Conclusion TAPB is the most comprehensive local anesthetic technique for postoperative CS analgesia in the absence of intrathecal morphine.

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Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Local Anesthetic Techniques for Postoperative Analgesia After Cesarean Section: A Bayesian Network Meta-Analysis of Randomized Controlled Trials

Wang¹,

Zhao²,

Song³

et al. 2021

JPR

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“…Since then, several new approaches of QLB have been described, but the exact mechanism of the analgesic effect of quadratus lumborum block remains under anatomical, radiological, and neurophysiological investigation [20]. The main focus of most studies assessing the effectiveness of QLB and intrathecal morphine (ITM) is opioid consumption, time to first analgesia, and pain severity in standardized pain scores (NRS, VAS, or NPSI-Neuropathic Pain Symptom Inventory) [1][2][3][4]21]. These studies indicate that most effective method in postoperative pain control after cesarean section remains the administration of ITM also when compared with QLB.…”

Section: Discussionmentioning

confidence: 99%

“…The exact mechanism of CPSP is still under debate and no targeted treatment is available at this time [30]. Although the occurrence of CPSP following cesarean section is lower than for other types of surgery [2], the constant increase in the number of cesarean sections globally makes CPSP a possible growing problem [31]. To date, few studies have been published assessing the possible effect of regional anesthesia on the occurrence of CPSP in patients after cesarean section [2,9,23].…”

Section: Discussionmentioning

confidence: 99%

“…Over several decades, there was a steady increase in the percentage of completed births by cesarean section globally [1]. Pain following cesarean section is somatic and visceral in nature and its inadequate treatment has both short-and long-term possible of 10 consequences, such as reluctance to feed the newborn, impaired early ambulation, reduced willingness for future pregnancies, or symptoms of chronic pain in the abdomen and pelvis [2]. Therefore, the optimal control of pain remains an important aspect of postoperative care in cesarean section [3].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Bilateral Quadratus Lumborum Block Type I on Patient Satisfaction and Incidence of Chronic Postsurgical Pain Following Cesarean Section-A Randomized Controlled Trial

Mieszkowski

Janiak

Borys

et al. 2021

IJERPH

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Background: Quadratus lumborum block (QLB) provides a reduction in pain scores and opioid consumption after cesarean section (CS). Intrathecal morphine (ITM) is still considered as the gold standard of acute postoperative pain therapy, but it does have some significant side effects. The aim of this clinical study was to evaluate whether performing the quadratus lumborum block type I in patients undergoing CS would be associated with an increased satisfaction of pain therapy and a decreased incidence of chronic postsurgical pain (CPSP). Methods: Sixty patients scheduled for elective CS were enrolled. All patients received spinal anesthesia and were randomly allocated to either the QLB group (received bilateral quadratus lumborum block type I with the use of 24 m mL 0.375% ropivacaine) or the control group (received no block). The level of satisfaction was evaluated using a three-step scale and the answers provided in a questionnaire regarding the patients’ satisfaction with the method of postoperative pain treatment in the first 48 h. After a 6-month period, all patients were interviewed to evaluate the incidence and possible severity of CPSP. Results: Satisfaction scores were significantly lower in the QLB group than in the control group (p = 0.0000). There were no significant differences between the QLB and control groups regarding the occurrence of chronic postsurgical pain after 6 months following CS (p = 0.102). No statistical differences between the groups were recorded when we compared the results of the questionnaire after a period of 48 h from CS (the number of participants were limited in number). Conclusions: QLB type I is an analgetic option that increased the satisfaction of parturients with pain therapy after CS compared to patients who did not receive the block, and there is a tendency for a lower incidence of CPSP.

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“…Quadratus lumborum block (QLB) is a relatively new regional anesthesia technique; it was developed by Blanco [7] and has been proposed as an analgesic alternative for use after many types of surgical procedures [8][9][10]. Several approaches to QLB have been reported [11], but only a few randomized controlled trials (RCT) [4,5,12,13] have evaluated the use of QLB for nephrectomies, all of which concerned laparoscopic procedures.…”

Section: Introductionmentioning

confidence: 99%

Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Decreases Persistent Postoperative Pain Severity in Patients Undergoing Both Open and Laparoscopic Nephrectomies—A Randomized Controlled Trial

Borys

Szajowska²,

Jednakiewicz³

et al. 2021

JCM

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Background: New regional techniques can improve pain management after nephrectomy. Methods: This study was a randomized controlled trial conducted at two teaching hospitals. Patients undergoing elective open and laparoscopic nephrectomy were eligible to participate in the trial. A total of 100 patients were divided into a quadratus lumborum block (QLB) group (50 patients) and a control (CON) group (50 patients). At the end of surgery, but while still under general anesthesia, unilateral QLB with ropivacaine was performed on the side of nephrectomy for patients in the QLB group. The main measured outcome of this study was oxycodone consumption via a patient-controlled anesthesia (PCA) pump during the first 24 h following surgery; other measured outcomes included postoperative pain intensity assessment, patient satisfaction with pain management, and persistent pain evaluation. Results: Patients undergoing QLB needed less oxycodone than those in the CON group (34.5 mg (interquartile range 23 to 40 mg) vs. 47.5 mg (35–50 mg); p < 0.001). No difference between the groups was seen in postoperative pain intensity measured on the visual analog scale, except for the evaluation at hour 2, which was in favor of the QLB group (p = 0.03). Patients who received QLB were more satisfied with postoperative pain management than the CON group. Persistent postoperative pain was assessed with the Neuropathic Pain Symptom Inventory (NPSI) at months 1, 3, and 6, and was found to be significantly lower in the QLB group at each evaluation (p < 0.001). We also analyzed the impact of the surgery type on persistent pain severity, which was significantly lower after laparoscopic procedures than open procedures at months 1, 3, and 6. Conclusions: QLB reduces oxycodone consumption in patients undergoing open and laparoscopic nephrectomy and decreases persistent pain severity months after hospital discharge.

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Quadratus Lumborum and Transversus Abdominis Plane Blocks and Their Impact on Acute and Chronic Pain in Patients after Cesarean Section: A Randomized Controlled Study

Cited by 20 publications

References 30 publications

The Efficacy and Safety of Local Anesthetic Techniques for Postoperative Analgesia After Cesarean Section: A Bayesian Network Meta-Analysis of Randomized Controlled Trials

The Efficacy and Safety of Local Anesthetic Techniques for Postoperative Analgesia After Cesarean Section: A Bayesian Network Meta-Analysis of Randomized Controlled Trials

Effect of Bilateral Quadratus Lumborum Block Type I on Patient Satisfaction and Incidence of Chronic Postsurgical Pain Following Cesarean Section-A Randomized Controlled Trial

Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Decreases Persistent Postoperative Pain Severity in Patients Undergoing Both Open and Laparoscopic Nephrectomies—A Randomized Controlled Trial

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