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

Uppal, Vishal; Retter, Susanne; E, Kehoe; McKeen, Dolores M.

doi:10.1007/s12630-020-01793-3

Cited by 37 publications

(31 citation statements)

References 52 publications

(264 reference statements)

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“…Third, we did not administer intrathecal opioids after CD to avoid interfering with the interfascial plane blocks. The issue of whether the addition of QLB to parturients receiving neuraxial morphine results in additional analgesic benefit compared with neuraxial morphine alone is still a point of discussion in meta-analyses and clinical studies [22,32,33]. Fourth, all parturients in the current study received the Joel-Cohen incision, but not Pfannenstiel incision.…”

Section: Discussionmentioning

confidence: 92%

Anterior Quadratus Lumborum Block at the Lateral Supra-Arcuate Ligament versus Transmuscular Quadratus Lumborum Block for Analgesia after Elective Cesarean Section: A Randomized Controlled Trial

Guo

Liu

et al. 2022

JCM

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Several studies have shown the effectiveness of trans-muscular quadratus lumborum block (TQLB) in analgesia after cesarean delivery. However, the influence of anterior QLB at the lateral supra-arcuate ligament (QLB-LSAL) in this surgery is unclear. This study aimed to compare the analgesic efficacy of bilateral TQLBs with bilateral QLBs-LSAL following cesarean delivery. Ninety-four parturients scheduled for cesarean delivery under spinal anesthesia were enrolled and randomly allocated to undergo either bilateral TQLBs or bilateral QLBs-LSAL with 0.375% of ropivacaine (20 mL each side) following cesarean delivery. Intravenous sufentanil was administered for patient-controlled analgesia (PCA). The primary outcome was postoperative sufentanil consumption during the initial 24 h post-surgery. Secondary endpoints included pain scores, time to the first PCA request, postoperative rescue analgesia, satisfaction scores, and nausea/vomiting events. Sufentanil consumption was significantly reduced in the QLB-LSAL group in the first 24 h compared with the TQLB group after surgery (29.4 ± 5.7 μg vs. 39.4 ± 9.6 μg, p < 0.001). In comparison with TQLB, the time to the first PCA request in the QLB-LSAL group was significantly longer (10.9 ± 4.1 h vs. 6.7 ± 1.8 h, p < 0.001). No differences were observed between two groups regarding pain scores, rescue analgesia after surgery, satisfaction scores, or nausea/vomiting incidence. The significant reduction in opioid consumption in the first 24 h and prolongation in time to first opioid demand in parturients receiving QLB-LSAL compared with TQLB suggest that the QLB-LSAL is a superior choice for multimodal analgesia after cesarean delivery.

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Section: Discussionmentioning

confidence: 92%

Anterior Quadratus Lumborum Block at the Lateral Supra-Arcuate Ligament versus Transmuscular Quadratus Lumborum Block for Analgesia after Elective Cesarean Section: A Randomized Controlled Trial

Guo

Liu

et al. 2022

JCM

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“…Two meta-analyses reported that the opioid consumption at 24 h after surgery was reduced in the QLB (using different QLB approaches) group. 5 , 24 Nevertheless, the subgroup analyses reported by Korgvee et al 5 demonstrated that QLB2 did not reduce opioid consumption at 24 h after surgery, compared with placebo, no block or other peripheral block. Their results are not consistent with those observed in the present meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Posterior Quadratus Lumborum Block for Acute Postoperative Analgesia in Adult Patients: A Meta-Analysis of Randomized Controlled Trials

Lin¹,

Wang²,

Qin³

et al. 2022

TCRM

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Objective The quadratus lumborum block provides postoperative analgesia for patients undergoing abdominal surgery, although there are three common approaches to perform this block. The present meta-analysis investigated the effectiveness of posterior quadratus lumborum block (QLB2) after surgery. Methods PubMed, Embase, and the Cochrane Central Register were searched from inception to 26 August 2021 for randomized controlled trials that evaluated the analgesic efficacy of QLB2 vs control (placebo or no block). The primary outcomes were pain scores at 6 h, 12 h, and 24 h after surgery. The secondary outcomes were morphine consumption at 24 h after surgery and the postoperative complications. Results The present meta-analysis included 14 studies conducted with a total of 1001 patients. In comparison to control group, the QLB2 group presented significantly lower rest pain scores at 6 h (SMD −0.59; 95% CI: −1.05, −0.12; p = 0.01, I 2 = 84%; GRADE = moderate), 12 h (SMD: –0.83; 95% CI: –1.47, –0.19; p = 0.01; I 2 = 88%; GRADE = low), and 24 h (SMD: –0.37; 95% CI: –0.71, –0.03; p = 0.03; I 2 = 80%; GRADE = moderate) after surgery. The dynamic pain scores were significantly reduced, compared to control, in the QLB2 group at 12 h (SMD: –0.93; 95% CI: –1.52, –0.33; p = 0.002; I 2 = 83%; GRADE = low) and 24 h (SMD: –0.52; 95% CI: –0.93, –0.11; p = 0.01; I 2 = 83%; GRADE = moderate) after surgery. In addition, the QLB2 group presented reduced postoperative opioid consumption at 24 h (SMD: –0.45; 95% CI: –0.86, –0.03; p = 0.03; I 2 = 78%; GRADE = moderate). The subgroup analyses revealed that the analgesic benefit of QLB2 did not persist beyond 24 h when the patients were under spinal anesthesia. Conclusion Ultrasound-guided QLB2 could provide effective analgesia for patients under general anesthesia by decreasing the intensity of pain and opioid requirement when used within 24 h after abdominal surgery.

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“…Another meta-analysis showed that QLB had a better postoperative analgesic effect than placebo after abdominal wall and hip surgeries. However, the advantages were less pronounced than other analgesic techniques [ 42 ]. Wang et al [ 38 ] assessed the efficacy of lateral QLB on postoperative pain in patients undergoing laparoscopic colorectal surgery.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Quadratus Lumborum Block Enhances the Quality of Recovery after Gastrointestinal Surgery: A Randomized Controlled Trial

Liu

Dai

Xie

et al. 2022

Pain Research and Management

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Background. Quadratus lumborum block (QLB) has been used to reduce postoperative acute pain and opioid consumption. However, the efficacy of QLB on the quality of recovery (QoR) after gastrointestinal surgery has not been established. The aim of this study was to evaluate the ability of QLB to enhance the postoperative QoR in patients undergoing open gastrointestinal surgery. Methods. Eighty-four patients undergoing open gastrointestinal surgery were randomized to receive ultrasound-guided QLB with either 20 ml of 0.375% ropivacaine or saline. The primary outcome was the QoR-15 score at 24 h after surgery. The secondary outcomes were the postoperative pain intensity, opioid consumption, the incidence of nausea, vomiting, and chronic pain. Results. The global QoR-15 score at 24 h postoperatively was significantly higher in the QLB group than in the control group (mean difference: 16.9; 95% CI: 11.9–21.9). Additionally, the QoR-15 scores for five dimensions were significantly higher in the QLB group than in the control group. The cumulative oxycodone consumption was significantly lower in the QLB group during 0–6, 6–24, 0–24, 24–48, and 0–48 h postoperatively than in the control group. At rest or during coughing, the pain verbal rating scale scores were significantly lower at 1, 3, 6, 12, and 24 h after surgery in the QLB group than in the control group. The incidence of postoperative nausea was significantly different between the groups, but postoperative vomiting was not. Conclusion. Single-injection posteromedial QLB with ropivacaine enhanced the QoR at 48 h after surgery and improved analgesia during the early postoperative period in patients undergoing gastrointestinal surgery.

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

Cited by 37 publications

References 52 publications

Anterior Quadratus Lumborum Block at the Lateral Supra-Arcuate Ligament versus Transmuscular Quadratus Lumborum Block for Analgesia after Elective Cesarean Section: A Randomized Controlled Trial

Anterior Quadratus Lumborum Block at the Lateral Supra-Arcuate Ligament versus Transmuscular Quadratus Lumborum Block for Analgesia after Elective Cesarean Section: A Randomized Controlled Trial

Ultrasound-Guided Posterior Quadratus Lumborum Block for Acute Postoperative Analgesia in Adult Patients: A Meta-Analysis of Randomized Controlled Trials

Ultrasound-Guided Quadratus Lumborum Block Enhances the Quality of Recovery after Gastrointestinal Surgery: A Randomized Controlled Trial

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