Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Pain After Cesarean Delivery

Blanco, Rafael; Ansari, Tarek; Riad, Waleed; Shetty, Nanda

doi:10.1097/aap.0000000000000495

Cited by 359 publications

(313 citation statements)

References 18 publications

Supporting

Mentioning

271

Contrasting

Unclassified

Order By: Relevance

“…Conversely, the block within the QLM revealed the spread of the contrast towards the paravertebral space between Th4-L1 spaces [10,13,23]. The aim of our study was to confirm what Blanco indicated in 2007, that a new concept of the block of the abdominal wall of the inhibitory effect of somatic and visceral pain, the so called paravertebral block component, was beneficial [14,15]. There were no published studies evaluating the effectiveness of the QLB I and post-cesarean section until 2014, when the protocol of the clinical trial presented here was developed.…”

Section: Discussionsupporting

confidence: 68%

“…There were no published studies evaluating the effectiveness of the QLB I and post-cesarean section until 2014, when the protocol of the clinical trial presented here was developed. According to various studies published since 2015, the QLB and its variants are an effective analgesic tool compared with the TAPB due to the absence of the paravertebral component; a smaller scope of activities; and the possibility of fewer complications [15,16,24].…”

Section: Discussionmentioning

confidence: 99%

“…A unique component of the QLB is not only that it stops somatic pain but also that it inhibits visceral pain due to the spread of the local anesthetic to the paravertebral space. The analgesic's effectiveness and superiority over TAPB after a C-section from a posterior approach (QLB II) were shown by Blanco [14][15][16]. We hypothesized that QLB type I as part of a multimodal analgesic regimen would result in decreased opioid consumption and improved analgesia in the first 48 hours after a C-section.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Some blocks (such as Pecs and quadratus lumborum blocks) have undergone randomized investigation with trials of variable quality (Jadad scores raging from 2 to 4). [53][54][55][59][60][61]64,67,74 Other blocks (such as the pecto-intercostal fascial plane blocks) are still searching for a legitimate application. 65,66 A few, such as US-guided thyroid capsular sheath blocks, may never find a clinical role because of sheer interference with the surgical field.…”

Section: Limitations Of Ultrasound Guidancementioning

confidence: 99%

Beyond Ultrasound Guidance for Regional Anesthesiology

Tran

Boezaart

Neal

2017

Regional Anesthesia and Pain Medicine

View full text Add to dashboard Cite

Despite its popularity, ultrasound (US)-guided regional anesthesiology is associated with significant limitations. The latter can be attributed to either the US machine (ie, decreased ability to insonate deep neural structures, as well as the thoracic spine) or the operator. Shortcomings associated with the operator can be explained by errors in perception (ie, ambiguous criteria for needle/catheter tip-to-nerve proximity and subparaneural local anesthetic injection) or interpretation. Perhaps the greatest confusion afflicting US-guided regional anesthesiology originates from an intellectual misconception pertaining to its application. Increasingly, authors are using US to identify interfascial planes where local anesthetic can be injected thereby "discovering" new truncal blocks. Often these novel blocks suffer from a lack of proper randomized, comparative validation.Fortunately, solutions have been proposed to remedy many shortcomings associated with US guidance. The inability of US to reliably insonate deep neural structures can be circumvented with adjunctive neurostimulation. Fluoroscopy and waveform analysis have been proven to increase the success rate of thoracic epidural blocks. For continuous nerve blocks, combined US-neurostimulation may provide an objective end point (ie, an evoked motor response) for neural proximity and subparaneural positioning of the catheter tip. Finally, the solution to the plethora of nonvalidated US-guided blocks is both elegant and simple. New nerve blocks should answer a specific clinical need, and their first descriptions should take the form of an adequately powered, observer-blinded, randomized comparison against the established standard of care or, at the very least, a large case series (eg, a Brief Technical Report).

show abstract

“…The anterior QL block can also provide analgesia from T10 to L3 [76]. A study by Blanco et al [77,78] …”

Section: Evidence and Clinical Applicationsmentioning

confidence: 99%

Ultrasound-guided truncal blocks for perioperative analgesia

Koh

Lee

2018

Anesth Pain Med

View full text Add to dashboard Cite

Since the widespread introduction of ultrasound for assisting techniques used in anesthetic theatres, peripheral nerve blocks of the trunk have been used more frequently to produce analgesia and anesthesia for surgeries involving the thorax, abdomen, and lower extremities. The introduction of real-time ultrasound has allowed the peripheral nerves, planes, and plexuses of the trunk to be located more accurately and has improved the success rate of truncal blocks The widespread application of ultrasound in clinical anesthesiology has led to an increase in the number of practitioners performing peripheral nerve blocks of the trunk to produce analgesia and anesthesia for surgeries involving the thorax, abdomen, and lower extremities. The use of real-time ultrasound has allowed the peripheral nerves, planes, and plexuses of the trunk to be located more accurately and has improved the success rate of blocks. Compared to central neuraxial techniques, many types of truncal blocks are relatively easy to perform and have low side effect profiles. As a result, truncal blocks have been introduced to provide perioperative analgesia for surgeries involving the thorax and abdomen. The most frequently used truncal block techniques include the paravertebral block, intercostal block, pectoralis and serratus anterior block, rectus sheath block, transversus abdominis plane block, and ilioinguinal and iliohypogastric nerve blocks. Recently introduced techniques also include the quadratus lumborum and erector spinae plane blocks. To apply each block correctly and reduce the likelihood of related side effects and complications, the practitioner must have a thorough understanding of the anatomical region, optimal block positioning, and device selection and management.

show abstract

Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Pain After Cesarean Delivery

Abstract: The quadratus lumborum block was more effective in reducing morphine consumption and demands than transversus abdominis plane blocks after cesarean section. This effect was observed up to 48 hours postoperatively.

Cited by 359 publications

References 18 publications

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

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

Beyond Ultrasound Guidance for Regional Anesthesiology

Ultrasound-guided truncal blocks for perioperative analgesia

Contact Info

Product

Resources

About