Ultrasound-guided transmuscular quadratus lumborum block for elective cesarean section significantly reduces postoperative opioid consumption and prolongs time to first opioid request: a double-blind randomized trial

BackgroundElective cesarean section (ECS) can cause moderate to severe pain that often requires opioid administration. To enhance maternal recovery, and promote mother and baby interaction, it is important to reduce postoperative pain and opioid consumption. Various regional anesthesia techniques have been implemented to improve postoperative pain management following ECS. This study aimed to investigate the efficacy of bilateral ultrasound-guided transmuscular quadratus lumborum (TQL) block on reducing postoperative opioid consumption following ECS.MethodsA randomized double-blind trial with concealed allocation was conducted in 72 parturients who received bilateral TQL block with either 30 mL ropivacaine 0.375% or saline. TQL block injectate was deposited in the interfascial plane between the quadratus lumborum and psoas major muscles, posterior to the transversalis fascia. Primary outcome was opioid consumption, which was recorded electronically. Pain scores and time to first opioid request were also evaluated.ResultsOpioid consumption (oral morphine equivalents, OME) was significantly reduced in group ropivacaine (GRO) in the first 24 hours compared with group saline (65 mg OME vs 94 mg OME) with a mean difference of 29 mg OME; 95% CI 3 to 55, p<0.03. Time to first opioid request was significantly prolonged in GRO, p<0.003. Numerical rating scale pain scores were significantly lower in GRO in the first 6 hours after surgery, p<0.03.ConclusionsBilateral TQL block significantly reduced 24 hours’ opioid consumption. Further, we observed significant prolongation in time to first opioid, and significant reduction of pain during the first 6 postoperative hours.

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Ultrasound-guided Transmuscular Quadratus Lumborum Block for Elective Cesarean Section Significantly Reduces Postoperative Opioid Consumption and Prolongs Time to First Opioid Request

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000661516.49927.c7 ◽

2020 ◽

Vol 40 (2) ◽

pp. 107-108

Author(s):

C.K. Hansen ◽

M. Dam ◽

G.E. Steingrimsdottir ◽

G.H. Laier ◽

M. Lebech ◽

...

Keyword(s):

Cesarean Section ◽

Opioid Consumption ◽

Elective Cesarean Section ◽

Ultrasound Guided ◽

Quadratus Lumborum Block ◽

Quadratus Lumborum ◽

Elective Cesarean

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Comparison Between Ultrasound Guided Transversalis Fascia Plane and Transversus Abdominis Plane Block on Postoperative Pain in Patients Undergoing Elective Cesarean Section

Iranian Red Crescent Medical Journal ◽

10.5812/ircmj.67844 ◽

2018 ◽

Vol In Press (In Press) ◽

Cited By ~ 4

Author(s):

Poupak Rahimzadeh ◽

Seyed Hamid Reza Faiz ◽

Farnad Imani ◽

Masoumeh Rahimian Jahromi

Keyword(s):

Postoperative Pain ◽

Cesarean Section ◽

Transversus Abdominis Plane Block ◽

Transversus Abdominis ◽

Elective Cesarean Section ◽

Transversalis Fascia ◽

Transversus Abdominis Plane ◽

Ultrasound Guided ◽

Elective Cesarean

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Transversus abdominis Plane Block for Improved Early Postoperative Pain Management after Periacetabular Osteotomy: A Randomized Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm10030394 ◽

2021 ◽

Vol 10 (3) ◽

pp. 394

Author(s):

Jannis Löchel ◽

Viktor Janz ◽

Vincent Justus Leopold ◽

Michael Krämer ◽

Georgi I. Wassilew

Keyword(s):

Postoperative Pain ◽

Periacetabular Osteotomy ◽

Opioid Consumption ◽

Transversus Abdominis ◽

Control Group ◽

Block Group ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Ultrasound Guided ◽

Pain Scores

Background: Patients undergoing periacetabular osteotomy (PAO) may experience significant postoperative pain due to the extensive approach and multiple osteotomies. The aim of this study was to assess the efficacy of the transversus abdominis plane (TAP) block on reducing opioid consumption and improving clinical outcome in PAO patients. Patients and Methods: We conducted a two-group randomized-controlled trial in 42 consecutive patients undergoing a PAO for symptomatic developmental dysplasia of the hip (DDH). The study group received an ultrasound-guided TAP block with 20 mL of 0.75% ropivacaine prior to surgery. The control group did not receive a TAP block. All patients received a multimodal analgesia with nonsteroidal anti-inflammatory drugs (NSAID) (etoricoxib and metamizole) and an intravenous patient-controlled analgesia (PCA) with piritramide (1.5 mg bolus, 10 min lockout-time). The primary endpoint was opioid consumption within 48 h after surgery. Secondary endpoints were pain scores, assessment of postoperative nausea and vomiting (PONV), measurement of the quality of recovery using patient-reported outcome measure and length of hospital stay. Forty-one patients (n = 21 TAP block group, n = 20 control group) completed the study, per protocol. One patient was lost to follow-up. Thirty-three were women (88.5%) and eight men (19.5%). The mean age at the time of surgery was 28 years (18–43, SD ± 7.4). All TAP blocks were performed by an experienced senior anaesthesiologist and all operations were performed by a single, high volume surgeon. Results: The opioid consumption in the TAP block group was significantly lower compared to the control group at 6 (3 mg ± 2.8 vs. 10.8 mg ± 5.6, p < 0.0001), 24 (18.4 ± 16.2 vs. 30.8 ± 16.4, p = 0.01) and 48 h (29.1 mg ± 30.7 vs. 54.7 ± 29.6, p = 0.04) after surgery. Pain scores were significantly reduced in the TAP block group at 24 h after surgery. There were no other differences in secondary outcome parameters. No perioperative complication occurred in either group. Conclusion: Ultrasound-guided TAP block significantly reduces the perioperative opioid consumption in patients undergoing PAO.

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Effect of Anesthesia Techniques on Pain Severity, Hemodynamic Changes, and Patients’ Satisfaction in Elective Cesarean Section

ACTA MEDICA IRANICA ◽

10.18502/acta.v57i7.2328 ◽

2020 ◽

Author(s):

Abdollah Jafarzadeh ◽

Maryam Hadavi ◽

Gholamhossein Hasanshahi ◽

Mohsen Rezaeian ◽

Reza Vazirinejad ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Postoperative Pain ◽

Cesarean Section ◽

Diastolic Blood Pressure ◽

Elective Cesarean Section ◽

Hemodynamic Changes ◽

Apgar Scores ◽

Patients Satisfaction ◽

Elective Cesarean

The severity of postoperative pain and hemodynamic changes during and post-cesarean section have a direct effect on the neonatal and maternal condition. This study aimed to compare pain severity, hemodynamic changes, and patient satisfaction following two anesthesia techniques in elective cesarean section. In this blinded study, 60 women who were candidate for cesarean section were allocated into two equal groups of general anesthesia (GA) and spinal anesthesia (SA). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and O2 Saturation at pre cesarean (T0), the uterine incision time (T1), end of surgery (T2), 6h (T3), 12h (T4), and 24 hours post-cesarean (T5) were measured. A Visual Analog Scale assessed post-cesarean pain, 6, 12, and 24 hours post-cesarean. Gender, birth weight, first- and fifth- minutes’ apgar score was recorded in the checklists. The VAS score was significantly higher in the GA group at 6h, 12h, and 24 hours post-cesarean (P=0.014, P=0.002, P=0.017, respectively). SBP and DBP at T1 in the GA group were significantly higher than in the S.A group (P<0.001). The heart rate at T0 and T1 in the GA group was lower than the SA group (P=0.001, P=0.045 respectively). The difference between the apgar scores of the two groups was not significant. SA for cesarean section was associated with lower postoperative pain, systolic and diastolic blood pressure. However, the two groups had no significant difference in terms of patients’ satisfaction and apgar scores. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(7):424-429.

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Efficacy of Phenylephrine in Preventing Hemodynamic Responses of Oxytocin during Elective Cesarean Section: A Randomized, Double-Blind, Controlled Trial

Annals of the National Academy of Medical Sciences (India) ◽

10.1055/s-0039-1694079 ◽

2019 ◽

Vol 55 (01) ◽

pp. 048-053

Author(s):

Medha Mohta ◽

Vijay Kumar ◽

Rachna Agarwal ◽

Geetanjali T. Chilkoti ◽

Sakshi Duggal

Keyword(s):

Cesarean Section ◽

Normal Saline ◽

Controlled Trial ◽

Saline Group ◽

Elective Cesarean Section ◽

Hemodynamic Changes ◽

Singleton Pregnancy ◽

Double Blind ◽

Elective Cesarean ◽

Better Than

AbstractThis study compared hemodynamic changes and occurrence of complications following oxytocin administration with a prior injection of phenylephrine 100 μg or normal saline during elective cesarean section. Sixty-six healthy term parturients with uncomplicated, singleton pregnancy undergoing elective cesarean section under spinal anesthesia were studied. They received either intravenous phenylephrine 100 μg or normal saline before oxytocin 3 IU was administered over 30 seconds. Oxytocin dose was repeated depending on the adequacy of uterine tone. There was no significant change in systolic, diastolic, and mean arterial pressures during the initial 3 minutes following oxytocin administration in the phenylephrine group but a significant fall in mean and diastolic pressures in the saline group. Heart rate did not change significantly, and no significant complications occurred in either of the groups. To conclude, phenylephrine 100 μg administered before oxytocin injection maintained hemodynamic parameters better than normal saline injection during elective cesarean section.

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Ultrasound-guided anterior and posterior quadratus lumborum block for analgesia after laparoscopic hysterectomy

Pain Management ◽

10.2217/pmt-2020-0008 ◽

2021 ◽

Vol 11 (1) ◽

pp. 5-8

Author(s):

Neha Singh ◽

Parnandi Bhaskar Rao ◽

Anirudh Elayat

Keyword(s):

Patient Satisfaction ◽

Postoperative Pain ◽

Pain Relief ◽

Laparoscopic Hysterectomy ◽

Multimodal Analgesia ◽

Total Laparoscopic Hysterectomy ◽

Opioid Consumption ◽

Ultrasound Guided ◽

Analog Scale ◽

Quadratus Lumborum

Aim: Laparoscopic procedures are now preferred over open surgeries, and total laparoscopic hysterectomy is becoming increasingly popular. Quadratus lumborum (QL) block is an evolving technique for abdominal surgeries that blocks T5–L1 nerve branches. Methods: We used a combination of anterior and posterior QL block given bilaterally in two patients and evaluated perioperative opioid consumption, postoperative pain score and patient satisfaction. Results: There was reduced perioperative opioid consumption along with postoperative visual analog scale for pain over the first 24 h. Both patients appreciated the level and standard of pain relief. Conclusion: QL block is promising as a part of multimodal analgesia for laparoscopic abdominal surgeries. Further studies are needed to determine the best possible combination of different approaches to QL block.

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