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

Pangthipampai, Pawinee; Dejarkom, Sukanya; Poolsuppasit, Suppachai; Luansritisakul, Choopong; Tangchittam, Suwida

doi:10.21203/rs.3.rs-36911/v1

Cited by 1 publication

(16 citation statements)

References 26 publications

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“…The initial search strategy identified 77 unique citations. Further search of the gray literature (Chinese Academic Full-text Database) yielded two 38,39 potentially eligible citations, and an additional three [40][41][42] were identified through correspondence with the authors of completed and ongoing trials registered on http://www.clinicaltrials.gov. These three trials [40][41][42] were subsequently published in the form of abstracts 40,41 and a full-text article.…”

Section: Resultsmentioning

confidence: 99%

“…Further search of the gray literature (Chinese Academic Full-text Database) yielded two 38,39 potentially eligible citations, and an additional three [40][41][42] were identified through correspondence with the authors of completed and ongoing trials registered on http://www.clinicaltrials.gov. These three trials [40][41][42] were subsequently published in the form of abstracts 40,41 and a full-text article. 42 After extensive review of individual title and abstracts alone of the 82 citations, a total of 66 were excluded because of nonrandomization (n = 56), incorrect intervention (n = 6), and incorrect study population (n = 4).…”

Section: Resultsmentioning

confidence: 99%

“…These three trials [40][41][42] were subsequently published in the form of abstracts 40,41 and a full-text article. 42 After extensive review of individual title and abstracts alone of the 82 citations, a total of 66 were excluded because of nonrandomization (n = 56), incorrect intervention (n = 6), and incorrect study population (n = 4). The remaining 16 citations had their fulltext versions retrieved for evaluation of eligibility.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…After correspondence with authors of the included studies, authors of four trials [4][5][6]46 provided additional details regarding methodology, and authors of three trials provided additional data that were subsequently confirmed when their work was published in the form of an abstract 40,41 or full article. 42 Only one study 7 required data extraction using GraphClick.…”

Section: Resultsmentioning

confidence: 99%

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

Hussain¹,

Brull²,

Weaver³

et al. 2020

Anesthesiology

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Background Spinal morphine is the mainstay of postcesarean analgesia. Quadratus lumborum block has recently been proposed as an adjunct or alternative to spinal morphine. The authors evaluated the analgesic effectiveness of quadratus lumborum block in cesarean delivery with and without spinal morphine. Methods Randomized trials evaluating quadratus lumborum block benefits in elective cesarean delivery under spinal anesthesia were sought. Three comparisons were considered: spinal morphine versus spinal morphine and quadratus lumborum block; spinal morphine versus quadratus lumborum block; and no block or spinal morphine versus quadratus lumborum block. The two coprimary outcomes were postoperative (1) 24-h cumulative oral morphine equivalent consumption and (2) pain at 4 to 6 h. Secondary outcomes included area under the curve pain, time to analgesic request, block complications, and opioid-related side effects. Results Twelve trials (924 patients) were analyzed. The mean differences (95% CIs) in 24-h morphine consumption and pain at 4 to 6 h for spinal morphine versus spinal morphine and quadratus lumborum block comparison were 0 mg (−2 to 1) and −0.1 cm (−0.7 to 0.4), respectively, indicating no benefit. For spinal morphine versus quadratus lumborum block, these differences were 7 mg (−2 to 15) and 0.6 cm (−0.7 to 1.8), respectively, also indicating no benefit. In contrast, for no block or spinal morphine versus quadratus lumborum block, improvements of −18 mg (−28 to −7) and −1.5 cm (−2.4 to −0.6) were observed, respectively, with quadratus lumborum block. Finally, for no block or spinal morphine versus quadratus lumborum block, quadratus lumborum block improved area under the 48-h pain curve by −4.4 cm · h (−5.0 to −3.8), exceeding the clinically important threshold (3.96 cm · h), but no differences were observed in the other comparisons. Conclusions Moderate quality evidence suggests that quadratus lumborum block does not enhance analgesic outcomes when combined with or compared with spinal morphine. However, the block improves postcesarean analgesia in the absence of spinal morphine. The clinical utility of this block seems limited to situations in which spinal morphine is not used. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Resultsmentioning

confidence: 99%