The analgesic efficacy of quadratus lumborum block in caesarean delivery: a meta-analysis and trial sequential analysis

Singh, Narinder Pal; Makkar, Jeetinder Kaur; Borle, Anuradha; Monks, David T.; Goudra, Basavana Gouda; Zorrilla-Vaca, Andrés; Singh, Preet Mohinder

doi:10.1007/s00540-020-02822-7

Cited by 8 publications

(14 citation statements)

References 23 publications

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“…The QLB is a block of the fascial plane that involves injecting local anesthetic adjacent to the quadratus lumborum (QL) muscle to anesthetize the thoracolumbar nerves, and includes 3 types: lateral (QLB type I), posterior (QLB type II), and transmuscular (QLB type III) approaches (3)(4)(5) , all of them were successfully utilized for post-CS analgesia. The QLB improves post-CS analgesia in the absence of spinal morphine, but the proper approach after CS is yet to be determined (6)(7)(8)(9)(10)(11) .…”

Section: Introductionmentioning

confidence: 99%

Quadratus Lumborum Block for Analgesia after Cesarean Section with Spinal Anesthesia: A Randomized Controlled Study

Tawfik

Helal²,

Motawea³

et al. 2022

The Egyptian Journal of Hospital Medicine

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Background: Quadratus lumborum block (QLB) was introduced to provide postoperative analgesia. Objective: This randomized controlled, double-blind study aimed to evaluate bilateral posterior QLB for analgesia after cesarean section (CS) using spinal anesthesia without intrathecal morphine. Methods: One hundred ASA-II women with singleton, full-term pregnancy undergoing CS using spinal anesthesia were randomized into 2 groups (Quadratus Lumborum and Control; 50 subjects each). After completing CS, bilateral posterior QLB (20 mL bupivacaine 0.25% on each side) was performed in Quadratus Lumborum group, and bilateral sham procedure was performed in Control group. Results: The median (range) of pain score at rest at 6 h was 2 (1-6) in Quadratus Lumborum group and 5 (2-8) in Control group; median difference (95% CI) was -3 (-3.000007 to -2.99995); P <0.00001. Pain score at rest at 12 h and pain scores on movement at 6 and 12 h were lower in Quadratus Lumborum group. No significant differences in pain scores at rest and pain scores on movement at 24 h were detected between the groups. The number of subjects requesting morphine was smaller, time to the first request of morphine was longer, and total morphine dose was smaller in Quadratus Lumborum group. Patient satisfaction was greater in Quadratus Lumborum group. No significant differences in the incidence of pruritus and nausea/vomiting were detected between the groups. Conclusions: QLB provides adequate postoperative analgesia after CS using spinal anesthesia without intrathecal morphine.

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Section: Introductionmentioning

confidence: 99%

Quadratus Lumborum Block for Analgesia after Cesarean Section with Spinal Anesthesia: A Randomized Controlled Study

Tawfik

Helal²,

Motawea³

et al. 2022

The Egyptian Journal of Hospital Medicine

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“…However, intravenous administrations of opioids by PCA may result in adverse events including pruritis, dizziness, nausea and vomiting, and paralytic ileus. Together with excessive sedation, these adverse events may hinder recovery, aggravate the formation of hypercoagulant thrombosis, and even partly affect the newborn through breastfeeding [5].…”

Section: Introductionmentioning

confidence: 99%

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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“…Quadratus lumborum block (QLB) was recently proposed as an alternative technique for post-cesarean delivery analgesia [ 3 – 6 ]. It involves local anesthetic injection into the thoracolumbar fascia adjacent to the quadratus lumborum muscle, which may facilitate the spread of local anesthetic into the thoracic paravertebral space [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…It involves local anesthetic injection into the thoracolumbar fascia adjacent to the quadratus lumborum muscle, which may facilitate the spread of local anesthetic into the thoracic paravertebral space [ 5 ]. QLB significantly reduces opioid requirements and improves analgesic effects after cesarean delivery [ 6 , 7 ]. Several meta-analyses have proven that bilateral QLB significantly reduces 24-hour opioid consumption after cesarean section [ 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

The minimum effective concentration (MEC90) of ropivacaine for ultrasound-guided quadratus lumborum block for analgesia after cesarean delivery: a dose finding study

Cao

Yang

et al. 2022

BMC Anesthesiol

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Background Quadratus lumborum block was recently proposed as an alternative technique for post-cesarean delivery analgesia. However, there is not a definite optimum concentration of local anesthetics. A biased coin design up-and-down method was used to explore the minimum effective concentration of ropivacaine in quadratus lumborum block for satisfactory analgesia after cesarean delivery. Methods Fifty-six patients weighing 60–80 kg after cesarean section and with ages between 18 and 40 years were recruited. For the posterior quadratus lumborum block, a volume of 25 ml of the assigned concentration of ropivacaine was injected bilaterally. The concentration administered to each patient depended on the response to the previous dose. The first patient received 0.25%. If a successful block was observed, the next patient was randomized to receive the same ropivacaine concentration (with a probability of 0.89) or 0.025% less (with a probability of 0.11). After any block failure, the concentration was always increased by 0.025% for the next. The study ended when 45 successful blocks were obtained. We defined effective quadratus lumborum block as a resting visual analog score ≤ 3 and the absence of a need for rescue anesthetics. Results The 90% minimum effective concentration of ropivacaine was 0.335% (95% CI 0.306 to 0.375%), and the 99% minimum effective concentration was 0.371% (95% CI 0.355 to 0.375%). The sufentanil consumption was 11 (11,13) and 24 (22,27) μg at 12 and 24 hours after quadratus lumborum block, respectively. Conclusions The optimum dosage of ropivacaine is a 25 ml volume of 0.335% for quadratus lumborum block after cesarean delivery. Trial registration The study was registered in the Chinese Clinical Trial Registry (No. ChiCTR2000040415).

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The analgesic efficacy of quadratus lumborum block in caesarean delivery: a meta-analysis and trial sequential analysis

Cited by 8 publications

References 23 publications

Quadratus Lumborum Block for Analgesia after Cesarean Section with Spinal Anesthesia: A Randomized Controlled Study

Quadratus Lumborum Block for Analgesia after Cesarean Section with Spinal Anesthesia: A Randomized Controlled Study

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

The minimum effective concentration (MEC90) of ropivacaine for ultrasound-guided quadratus lumborum block for analgesia after cesarean delivery: a dose finding study

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