Quadratus lumborum block versus transversus abdominis plane block for post Caesarean analgesia: A randomized prospective controlled study

Khanna, Sangeeta; Prasad, G. Lakshmi; Sharma, Vipin Jaishree; Biradar, Mallikarjun K; bhasin, Dinesh

doi:10.1016/j.mjafi.2020.10.009

Cited by 13 publications

(10 citation statements)

References 21 publications

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“…In the current work, we noted that VAS score of the studied groups over 48 hours was statistically significant lower VAS score in those who received QLB than those who received TAB except at 8 hours after the procedure, where there was a significant increase in QLB than TAB. These results are in line with Khanna et al (15) who aimed to study QLB versus TAP for post-CS analgesia and reported no significant differences at the first two hours after surgery. After that, there were significant differences and maximum differences were noted at 10 to 20 hours after procedure.…”

Section: Discussionsupporting

confidence: 91%

Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Analgesia after Caesarean Section

Abdeltawab,

Abo-Elkhair,

Radi

et al. 2023

SJMS

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Background and Aim: Effective postoperative analgesia after caesarean section is crucial for early ambulation and quality of life. Quadratus lumborum (QL) block is gaining wide acceptance for pain control after lower abdominal surgery. The current work aimed to compare between transversus abdominis plane (TAP) block and Quadratus Lumborum Block (QLB) in patients undergoing elective cesarean delivery (CD) under spinal anesthesia. Patients and Methods: The study included 200 patients who were divided randomly into two equal groups according to the type of anesthetic blocks (Ultrasound guided QLB and TAP block). All underwent cesarean delivery using Pfannenstiel incision and subarachnoid anesthesia with 0.25% bupivacaine. Preoperatively all women were assessed clinically and by laboratory investigations. The visual analogue scale (VAS) was the proper method for postoperative pain assessment. Women demographics and preoperative hemodynamics were recorded. After the procedure, hemodynamics and pain assessment was continued on regular intervals. The time for first analgesic request, the total dose of analgesics and any complications were documented. Results: QLB group had significantly lower pain score at 4 and 6 hours, and from 10 hours till the end of assessment duration. Both groups were comparable after surgery and at 2 hours. The heart rate and respiratory rate were significantly lower in the QLB than the TAB group. However, values were in normal range. The time for the first analgesic request was significantly longer in QLB than TAP block (458.79±39.68 vs 262.75±30.92 minutes. The total dose of analgesics was significantly lower in QLB than TAPB. The somatic pain reported by 17% and 45% in QLB and TAPB groups respectively. Conclusion: The Quadratus lumborum block was a safe, reliable, and effective option for postoperative pain relief after elective caesarean delivery. QLB was superior than the TAP block for pain control and both were comparable as the rate of complications.

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Section: Discussionsupporting

confidence: 91%

Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Analgesia after Caesarean Section

Abdeltawab,

Abo-Elkhair,

Radi

et al. 2023

SJMS

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“…We included 114 trials (8730 women) in our final network analysis, 73 (64%) of which reported the primary outcome of morphine equivalent dose in the first 24 postoperative hours for 5126 (59%) women (Fig. 1 and online Supporting Information, Table S1) [14–127]. Placebo vs. transversus abdominis plane injection in 11 trials was the most common direct comparison.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of regional blocks or local anaesthetic infiltration for analgesia after caesarean delivery: a network meta‐analysis of randomised controlled trials

et al. 2021

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Caesarean delivery is common and can cause severe postoperative pain but injection of local anaesthetic at various sites for regional blocks or local anaesthetic infiltration may reduce this. We aimed to compare and rank these sites. We searched PubMed, Google Scholar, EMBASE and CENTRAL to June 2021 for randomised controlled trials and performed a random-effects Bayesian model network meta-analysis. The primary outcome was dose of parenteral morphine equivalents in the first 24 postoperative hours. We used surface under cumulative ranking probabilities to order techniques. We analysed 114 trials (8730 participants). The ordered mean (95% credible interval) reduction in morphine equivalents, from 34 mg with placebo, were as follows: ilioinguinal 15 (1-32) mg; ilio-inguinal-iliohypogastric 13 (6-19) mg; transversalis fascia 11 (4-26) mg; erector spinae 11 (10-32); transverse abdominis 9 (4-13) mg; wound catheter infusion 8 (2-15) mg; quadratus lumborum 8 (1-15) mg; wound infiltration 8 (2-13) mg; and no intervention À4 (À10 to 2) mg. Ordered efficacies for injection sites were different for other relevant outcomes, including pain (to 4-6 h and to 24 h) and time to rescue analgesia: there was no single preferred route of injection. The ordered mean (95% credible interval) reduction in dynamic pain scores (0-10 scale) at 24 h compared with placebo were as follows: wound infusion 1.2 (0.2-2.1); erector spinae 1.3 (À0.5 to 3.1); quadratus lumborum 1.0 (0.1-1.8); ilio-inguinaliliohypogastric 0.6 (À0.5 to 1.8); transverse abdominis 0.6 (À0.1 to 1.2); wound infiltration 0.5 (À0.3 to 1.3); transversalis fascia À0.8 (À3.4 to 1.9); ilio-inguinal À0.9 (À3.6 to 1.7); and no intervention À0.8 (À1.8 to 0.2). We categorised our confidence in effect sizes as low or very low.

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“…Significant differences in pain scores at 6, 8, 10, 12, 16 and 20 hours postoperatively, by 24 hours postoperatively the difference ceased to be statistically significant. Time to rescue analgesia in QL group was 1353 minutes (±224.07) and TAP group was 915 minutes (±391.62) (P < 0.001) [31]. Although evidence appeared promising that the QL block is more effective than the TAP block for postoperative pain after caesarean section, a recent meta-analysis found that QL block and TAP block were equivalent and superior in their analgesic efficacy relative to inactive control for up to 48 hours and that QL block was not associated with a reduction in 24-hour IV morphine equivalent consumption when compared with TAP block [32].…”

Section: Quadratus Lumborum Blockmentioning

confidence: 94%

Perioperative Analgesia in Caesarean Section: What’s New?

Saucillo-Osuna¹,

Wilson-Manríquez²,

López-Hernández³

et al. 2023

Topics in Postoperative Pain

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Caesarean section is associated with moderate to severe postoperative pain during the first 24 hours after surgery. Inadequate pain management can influence recovery, maternal psychological well-being and breastfeeding. In the search of alternatives to minimize the use of systemic opioids, new recommendations have been made to implement protocols to improve recovery after caesarean section, with multimodal analgesia, new suggestions for neuraxial techniques, regional analgesia with ultrasound-guided fascial plane blocks and non-pharmacological approaches. Some of the interventions, such as epidural or spinal blocks, although effective, carry a significant risk of complications (for example post-puncture headache). In their place, newer alternatives such as interventions guided by ultrasound are safe and effective for relieving pain in this common clinical context. The goal of this chapter is to provide clinicians with up-to-date evidence for optimal pain management after elective caesarean section.

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Quadratus lumborum block versus transversus abdominis plane block for post Caesarean analgesia: A randomized prospective controlled study

Cited by 13 publications

References 21 publications

Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Analgesia after Caesarean Section

Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Analgesia after Caesarean Section

Efficacy of regional blocks or local anaesthetic infiltration for analgesia after caesarean delivery: a network meta‐analysis of randomised controlled trials

Perioperative Analgesia in Caesarean Section: What’s New?

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