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

Abstract

Background: Adequate pain control after cesarean section (CS) is crucial for mothers caring for newborns, and early ambulation to avoid thromboembolism and chronic abdominal and pelvic pain. This randomized controlled trial compared the efficacy of quadratus lumborum block (QLB) and intrathecal morphine (ITM) for analgesia after CS. Methods: Ninety women at ≥ 37 weeks pregnancy scheduled for elective CS were enrolled. All patients received spinal anesthesia and post-operative QLB. They were randomly allocated to Control (anesthesia: 0.1 ml saline, QLB: 24 ml saline), ITM (anesthesia: 0.1 mg morphine, QLB: 24 ml saline), or QLB groups (anesthesia: 0.1 ml saline, QLB: 24 ml 0.375% ropivacaine). Integrated analgesia score (IAS) and numerical rating scale (NRS) scores at rest and during movement, morphine requirements in the first 48 h, time to first morphine dose and morphine-related side effects were recorded. Results: IASs and NRS scores at rest and during movement were significantly lower in QLB and ITM group than in Control group. Moreover, IASs and NRS scores at rest and during movement were lower in QLB group than in ITM group. Time to first morphine dose was significantly longer in QLB group than in ITM and Control group. Furthermore, morphine requirements in the first 48 h were significantly lower in QLB group than ITM and Control group. Incidence of morphine-related side effects was significantly higher in ITM group than in QLB and Control group. Conclusions: QLB and ITM are effective analgesic regimens after CS. However, QLB provides better long-lasting analgesia and reduced total postoperative morphine consumption.

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

“…Compared with IT morphine alone, posterior QLB alone had a signi cantly shorter pain-free period, and patients required signi cantly more morphine during the rst 24 hours. This result is in contrast to the ndings of Salama ER, et al 16 who found the time to rst morphine dose to be signi cantly longer with QLB than IT morphine. Salama ER, et al reported a median (min, max) time of 8 h (3-24) in IT morphine vs. 17 in QLB, whereas we observed the median pain free period to be 2.50 h (95% CI: 1.04-3.96) in…”

Postoperative Analgesic Effectiveness of Quadratus Lumborum Block for Cesarean Delivery under Spinal Anesthesia

“…Of these, four were excluded because of nonrandomization 43 and incorrect comparison. 3,29,44 Thus, 12 full-text, randomized, controlled trials [4][5][6][7][8][38][39][40][41][42]45,46 were included in this systematic review and meta-analysis. Supplemental Digital Content 3 (http://links.…”

“…• Quadratus lumborum block does not provide analgesic benefit when compared with or in addition to spinal morphine for postcesarean analgesia • In patients who do not receive spinal morphine, quadratus lumborum block does offer analgesic and opioid consumption benefit S pinal morphine is considered to be the standard of care for postoperative analgesia after elective cesarean delivery performed under spinal anesthesia, 1 providing effective, safe, and cost-efficient analgesia up to 12 h postoperatively. 2 With the advent and recent proliferation of abdominal wall fascial plane blocks, including the relatively novel quadratus lumborum block, 3,4 investigators have reported that its use can improve postoperative pain relief when combined with 5,6 or used in place of spinal morphine, 7,8 after spinal anesthesia for cesarean delivery. The deposition of local anesthetic adjacent to the quadratus lumborum muscle not only treats the somatic pain associated with a Pfannenstiel incision but also spreads proximally to the paravertebral space 9,10 and may be advantageous in providing relief to the visceral component of postcesarean pain.…”

“…The study characteristics and outcomes assessed in this review are presented in table 1. All 12 randomized trials [4][5][6][7][8][38][39][40][41][42]45,46 included adult parturients undergoing elective cesarean delivery under spinal anesthesia. The included studies encompassed 924 patients.…”

“…Of those, 219 received spinal morphine, [5][6][7][40][41][42] 132 received spinal morphine and quadratus lumborum block, 5,6,40,42 324 received quadratus lumborum block (without spinal morphine), 4,5,7,8,[38][39][40][41]45,46 and 249 did not receive a block or spinal morphine. 4,5,7,8,38,39,45,46 The comparisons involved included four studies (n = 263 patients) 5,6,40,42 comparing spinal morphine with spinal morphine and quadratus lumborum block; four studies (n = 296 patients) 5,7,40,41 comparing spinal morphine with quadratus lumborum block; and eight studies (n = 498 patie nts) 4,5,7,8,38,39,45,46 comparing no block or spinal morphine with quadratus lumborum block. A total of 11 studies [4][5][6]…”