&lt;p&gt;Postoperative analgesic effects of various quadratus lumborum block approaches following cesarean section: a randomized controlled trial&lt;/p&gt;

Kang, Wenbin; Lu, Danbo; Yang, Xiaoyu; Zhou, Zhi‐Bin; Chen, Xi; Chen, Keyu; Zhou, Xue; Feng, Xia

doi:10.2147/jpr.s202772

Cited by 39 publications

(50 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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%

“…Metaregression was performed only if at least four studies were included in an estimate of effect and each group within the covariate included at least two randomized, controlled trials. The metaregression analysis examined the following covariates: (1) block approach (lateral, posterior, or anterior) 29,30 ; (2) block localization (ultrasound vs. landmark vs. paresthesia vs. nerve stimulator) 31,32 ; (3) short-/intermediate-acting (lidocaine and mepivacaine) versus long-acting (bupivacaine, levobupivacaine, and ropivacaine) local anesthetics 33 ; (4) local anesthetic dose in block (converted to milligrams of bupivacaine) 34 ; (5) local anesthetic volume in block (milliliters); (6) local anesthetic dose in spinal anesthetic (converted to milligrams of bupivacaine) 34 ; (7) type of short-acting narcotic used in spinal anesthetic (fentanyl vs. sufentanil vs. cocaine vs. none); (8) dose of long-acting narcotic used in spinal anesthetic (micrograms); (9) type of spinal anesthetic used (combined spinal epidural vs. single-injection spinal anesthetic); and (10) postoperative analgesic modality (multimodal = combines opioid and other adjuvants vs. unimodal = uses opioids only). 35,36 assessment of Publication Bias A funnel plot was generated and examined for publication bias in each of the outcomes assessed.…”

Section: Assessment Of Heterogeneitymentioning

confidence: 99%

See 1 more Smart Citation

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

Hussain¹,

Brull²,

Weaver³

et al. 2020

Anesthesiology

View full text Add to dashboard Cite

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

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Assessment Of Heterogeneitymentioning

confidence: 99%

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

Hussain¹,

Brull²,

Weaver³

et al. 2020

Anesthesiology

View full text Add to dashboard Cite

show abstract

“…A meta-analysis showed a comparable pain score between the low and high concentrations of local anesthetic, however, a higher dose may have improved and prolonged the analgesic effect [19]. The epidural block remained the effective approach to produce a reliable analgesia for abdominal surgery compared to the QLB because of the spread of local anesthetic was vary depending on the site of injection that was highly associated with the coverage and quality of analgesia [20, 21]. Therefore, the optimal dose of local anesthetic for QLB still needs to be determined.…”

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial on analgesic effect of repeated Quadratus Lumborum block versus continuous epidural analgesia following laparoscopic nephrectomy

et al. 2019

View full text Add to dashboard Cite

BackgroundEpidural analgesia as the effective pain management for abdominal surgery has side effects such as paresthesia, hypotension, hematomas, and impaired motoric of lower limbs. The quadratus lumborum block (QLB) has potential as an abdominal truncal block, however, its analgesic efficacy has never been compared to epidural analgesia on laparoscopic nephrectomy. This prospective randomized controlled study compared the effectiveness of QLB with the epidural analgesia technique in relieving postoperative pain following transperitoneal laparoscopic nephrectomy.MethodsSixty-two patients underwent laparoscopic donor nephrectomy and were randomized to receive QLB (n = 31) or continuous epidural (n = 31). The QLB group received bilateral QLB using 0.25% bupivacaine and the epidural group received 6 ml/h of 0.25% bupivacaine for intraoperative analgesia. As postoperative analgesia, the QLB group received repeated bilateral QLB with the same dose and the epidural group received 6 ml/h of 0.125% bupivacaine for 24 h after surgery completion. The primary outcome was the 24-h cumulative morphine requirement after surgery. The secondary outcome was the postoperative pain scores. Sensory block coverage, hemodynamic changes, Bromage score, postoperative nausea-vomiting (PONV), paresthesia, and duration of urinary catheter usage were recorded and analyzed.ResultThe 24-h cumulative morphine requirement and pain scores after surgery were comparable between the QLB and epidural groups. The coverage of QLB was extended from T9 to L2 and the continuous epidural block was extended from T8 to L3 dermatomes. The mean arterial pressure (MAP) measured at 24 h after surgery was lower in the epidural group (p = 0.001). Bromage score, incidence of PONV, and paresthesia were not significantly different between the two groups. Duration of urinary catheter usage was shorter (p < 0.001) in the QLB group.ConclusionThe repeated QLB had a similar 24-h cumulative morphine requirement, comparable postoperative pain scores and sensory blockade, higher postoperative MAP, a similar degree of motoric block, no difference in the incidence of PONV and paresthesia, and shorter urinary catheter usage, compared to the continuous epidural analgesia following transperitoneal laparoscopic nephrectomy.Trial registrationClinicalTrial.gov NCT03520205 retrospectively registered on May 9th 2018.

show abstract

“…There has been one randomised controlled trial comparing combined QLB approaches in the caesarean delivery population by Kang et al. The authors reported lower pain scores at rest and on movement up to 48 h with QLB combined posterior and anterior approaches compared with separate approaches [54]. The 48‐h morphine consumption in the combined group was 2.7 mg, compared with 6.1 mg and 5.7 mg in the posterior and anterior approaches separately.…”

Section: Caesarean Deliverymentioning

confidence: 99%

Regional anaesthesia for labour, operative vaginal delivery and caesarean delivery: a narrative review

Sultan

Carvalho

2021

Anaesthesia

View full text Add to dashboard Cite

Summary This narrative review discusses recent evidence surrounding the use of regional anaesthesia in the obstetric setting, including intrapartum techniques for labour and operative vaginal delivery, and caesarean delivery. Pudendal nerve blockade, ideally administered by an obstetrician, should be considered for operative vaginal delivery if neuraxial analgesia is contraindicated. Regional techniques are increasingly utilised in clinical practice for caesarean delivery to minimise opioid consumption, reduce pain, improve postpartum recovery and facilitate earlier discharge as part of enhanced recovery protocols. The evidence surrounding transversus abdominis plane and quadratus lumborum blockade supports their use when: long‐acting neuraxial opioids cannot be administered due to contraindications; if emergency delivery necessitates general anaesthesia; or as a postoperative rescue technique. Current data suggest quadratus lumborum blockade is no more effective than transversus abdominis plane blockade after caesarean delivery. Transversus abdominis plane blockade, wound catheter insertion and single shot wound infiltration are all effective techniques for reducing postoperative opioid consumption, with transversus abdominis plane blockade favoured, followed by wound catheters and then wound infiltration. Ilio‐inguinal and iliohypogastric, erector spinae plane and rectus sheath blockade all require further studies to determine their efficacy for caesarean delivery in the presence or absence of long‐acting neuraxial opioids. Future studies are needed to: compare approaches for individual techniques; determine which combinations of techniques and dosing regimens result in optimal analgesic and recovery outcomes following delivery; and elucidate the populations that benefit most from regional anaesthesia in the obstetric setting.

show abstract

<p>Postoperative analgesic effects of various quadratus lumborum block approaches following cesarean section: a randomized controlled trial</p>

Cited by 39 publications

References 27 publications

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

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

A randomized controlled trial on analgesic effect of repeated Quadratus Lumborum block versus continuous epidural analgesia following laparoscopic nephrectomy

Regional anaesthesia for labour, operative vaginal delivery and caesarean delivery: a narrative review

Contact Info

Product

Resources

About