Bilateral posterior Quadratus Lumborum block for pain relief after cesarean delivery: a randomized controlled trial

Abstract Background Achieving optimal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal (IT) morphine is the current standard but ultrasound-guided quadratus lumborum block (QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine, with IT morphine and bilateral QLB, or only bilateral QLB. Methods Parturients having elective cesarean delivery under spinal block were randomized and allocated into IT morphine 0.2 mg with sham QLB (Group IT), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group IT+QLB), or bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group QLB). A PCA pump was connected after completion of the QLB or sham block. The first time to PCA morphine requirement was recorded and compared. Results Eighty parturients were included. Analysis of Group QLB was terminated early because at the second interim analysis, median pain-free period was significantly shorter in Group QLB [hours (95%CI): 2.50 (1.04–3.96) in Group IT vs. 7.75 (5.67–9.83) in IT+QLB vs. 1.75 (0.75–2.75) in QLB (p < 0.001)]. The median (min, max) amount of morphine required during 24 h was 5.5 (0–25) in Group IT vs. 5.0 (0–36) in IT+QLB vs. 17.5 (1–40) mg in Group QLB (p < 0.001). In the final analysis the median pain-free period was 2.50 (1.23–3.77) hours (95%CI) in Group IT (n = 27) vs. 8.02 (5.96–10.07) in IT+QLB (n = 28). (p = 0.027). Conclusion US-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB could provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period. Trial registration ClinicalTrials.gov no. NCT03199170 Date registered on June 22, 2017. Prospectively registered.

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

10.21203/rs.3.rs-36911/v1 ◽

2020 ◽

Author(s):

Pawinee Pangthipampai ◽

Sukanya Dejarkom ◽

Suppachai Poolsuppasit ◽

Choopong Luansritisakul Luansritisakul ◽

Suwida Tangchittam

Keyword(s):

Side Effects ◽

Cesarean Delivery ◽

Pain Control ◽

Intrathecal Morphine ◽

Spinal Block ◽

Side Group ◽

Quadratus Lumborum Block ◽

Analgesic Regimen ◽

Quadratus Lumborum ◽

Median Pain

Abstract Background: Achieving optimal abdominal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal morphine is the current standard but ultrasound guided quadratus lumborum block (US-QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine 0.2 mg, with IT morphine 0.2 mg and bilateral QLB, or only bilateral QLB.Methods: Parturients having elective cesarean delivery with a low transverse incision under spinal block were randomized to three groups. Subjects were allocated into IT morphine 0.2 mg with sham QLB (Group IT morphine), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml and adrenaline 1:250,000 in each side (Group IT morphine with QLB), or bilateral QLB with 0.25% bupivacaine 25 ml and adrenaline 1:250,000 in each side (Group QLB). A PCA pump was connected to each parturient after completion of the QLB or sham block. The first time to PCA morphine requirement when parturients experienced pain was recorded and compared.Results: Eighty parturients were included. Analysis of Group QLB was terminated early because Kaplan-Meier survival analysis showed the median pain-free period to be significantly shorter in Group QLB at the second interim analysis; [2.50 hours (95% CI: 1.04-3.96) in Group IT morphine vs. 7.75 (95% CI: 5.67-9.83) in Group IT morphine with QLB vs. 1.75 (95% CI: 0.75-2.75) in Group QLB (overall p<0.001)]. The median (min, max) amount of morphine required during 24 hours was 5.5 (0-25) in Group IT morphine vs. 5.0 (0-36) in Group IT morphine with QLB vs. 17.5 (1-40) mg in Group QLB (p<0.001). In the final analysis the median pain-free period was 2.50 hours (95%CI: 1.23-3.77) in Group IT morphine (n=27) and 8.02 (95%CI: 5.96-10.07) in Group IT morphine with QLB (n=28). (Gehan-Breslow p=0.027).Conclusion: US-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB may provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period.Trial registration: ClinicalTrials.gov no. NCT03199170 Date registered on June 22, 2017. Prospectively registered.

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

10.21203/rs.3.rs-36911/v3 ◽

2021 ◽

Author(s):

Pawinee Pangthipampai ◽

Sukanya Dejarkom ◽

Suppachai Poolsuppasit ◽

Choopong Luansritisakul Luansritisakul ◽

Suwida Tangchittam

Keyword(s):

Side Effects ◽

Cesarean Delivery ◽

Pain Control ◽

Controlled Trial ◽

Spinal Block ◽

Side Group ◽

Quadratus Lumborum Block ◽

Analgesic Regimen ◽

Quadratus Lumborum ◽

Median Pain

Abstract Background: Achieving optimal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal (IT) morphine is the current standard but ultrasound-guided quadratus lumborum block (QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine, with IT morphine and bilateral QLB, or only bilateral QLB.Methods: Parturients having elective cesarean delivery under spinal block were randomized and allocated into IT morphine 0.2 mg with sham QLB (Group IT), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group IT+QLB), or bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group QLB). A PCA pump was connected after completion of the QLB or sham block. The first time to PCA morphine requirement was recorded and compared.Results: Eighty parturients were included. Analysis of Group QLB was terminated early because at the second interim analysis, median pain-free period is significantly shorter in Group QLB [hours (95%CI): 2.50 (1.04-3.96) in Group IT vs. 7.75 (5.67-9.83) in IT+QLB vs. 1.75 (0.75-2.75) in QLB (p<0.001)]. The median (min, max) amount of morphine required during 24 hours was 5.5 (0-25) in Group IT vs. 5.0 (0-36) in IT+QLB vs. 17.5 (1-40) mg in Group QLB (p<0.001). In the final analysis the median pain-free period was 2.50 (1.23-3.77) hours (95%CI) in Group IT (n=27) vs. 8.02 (5.96-10.07) in IT+QLB (n=28). (p=0.027).Conclusion: US-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB can provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period.

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

10.21203/rs.3.rs-36911/v2 ◽

2020 ◽

Author(s):

Pawinee Pangthipampai ◽

Sukanya Dejarkom ◽

Suppachai Poolsuppasit ◽

Choopong Luansritisakul Luansritisakul ◽

Suwida Tangchittam

Keyword(s):

Side Effects ◽

Cesarean Delivery ◽

Pain Control ◽

Controlled Trial ◽

Spinal Block ◽

Side Group ◽

Quadratus Lumborum Block ◽

Analgesic Regimen ◽

Quadratus Lumborum ◽

Median Pain

Abstract Background: Achieving optimal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal (IT) morphine is the current standard but ultrasound-guided quadratus lumborum block (QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine, with IT morphine and bilateral QLB, or only bilateral QLB. Methods: Parturients having elective cesarean delivery under spinal block were randomized and allocated into IT morphine 0.2 mg with sham QLB (Group IT), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group IT+QLB), or bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group QLB). A PCA pump was connected after completion of the QLB or sham block. The first time to PCA morphine requirement was recorded and compared. Results: Eighty parturients were included. Analysis of Group QLB was terminated early because at the second interim analysis, median pain-free period is significantly shorter in Group QLB [hours (95%CI): 2.50 (1.04-3.96) in Group IT vs. 7.75 (5.67-9.83) in IT+QLB vs. 1.75 (0.75-2.75) in QLB (p<0.001)]. The median (min, max) amount of morphine required during 24 hours was 5.5 (0-25) in Group IT vs. 5.0 (0-36) in IT+QLB vs. 17.5 (1-40) mg in Group QLB (p<0.001). In the final analysis the median pain-free period was 2.50 (1.23-3.77) hours (95%CI) in Group IT (n=27) vs. 8.02 (5.96-10.07) in IT+QLB (n=28). (p=0.027). Conclusion: US-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB can provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period.

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Faculty Opinions recommendation of The Analgesic Effect of Ultrasound-Guided Quadratus Lumborum Block After Cesarean Delivery: A Randomized Clinical Trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732114882.793545897 ◽

2018 ◽

Author(s):

Frédéric Mercier ◽

Karim Bouattour ◽

Mickaël Soued

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Cesarean Delivery ◽

Analgesic Effect ◽

Ultrasound Guided ◽

Quadratus Lumborum Block ◽

Quadratus Lumborum

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Faculty Opinions recommendation of The Analgesic Effect of Ultrasound-Guided Quadratus Lumborum Block After Cesarean Delivery: A Randomized Clinical Trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732114882.793545137 ◽

2018 ◽

Author(s):

Ashraf Habib

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Cesarean Delivery ◽

Analgesic Effect ◽

Ultrasound Guided ◽

Quadratus Lumborum Block ◽

Quadratus Lumborum

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Quadratus lumborum block for postoperative analgesia after cesarean delivery: a systematic review and meta-analysis

International Journal of Obstetric Anesthesia ◽

10.1016/j.ijoa.2020.02.005 ◽

2020 ◽

Vol 42 ◽

pp. 87-98 ◽

Cited By ~ 6

Author(s):

M. Xu ◽

Y Tang ◽

J. Wang ◽

J. Yang

Keyword(s):

Systematic Review ◽

Cesarean Delivery ◽

Postoperative Analgesia ◽

Meta Analysis ◽

Quadratus Lumborum Block ◽

Quadratus Lumborum

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Ultrasound-Guided Quadratus Lumborum Block as A Postoperative Analgesia for Total Abdominal Hysterectomy: A Case Report

10.21203/rs.3.rs-402952/v2 ◽

2021 ◽

Author(s):

Haytham El Sayed Mohamed ◽

Fadheela Al Najar ◽

Mohamed Nasr Awad ◽

Faten M Hassan

Keyword(s):

Side Effects ◽

Abdominal Surgery ◽

Analgesic Effect ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Multimodal Analgesia ◽

Ultrasound Guided ◽

Quadratus Lumborum Block ◽

Quadratus Lumborum ◽

Obstructive Sleep

Abstract Background and aim: Total Abdominal Hysterectomy is a major invasive abdominal surgery which is accompanied with severe postoperative pain. Multimodal analgesia techniques can provide efficient analgesics coverage with minimal side effects, Quadratus Lumborum Block is an abdominal wall block which gives a good analgesic effect for abdominal surgery with lower pain score and less opioids requirements.Case presentation: A 67 years old female was scheduled to undergo total abdominal hysterectomy surgery, she had comorbidities; morbid obesity, bronchial asthma, obstructive sleep apnea, and hypothyroidism. We performed General Anesthesia and by the end of surgery, a Quadratus Lumborum Block was done ultrasound-guided technique.Conclusion: We successfully performed Quadratus Lumborum Block bilaterally which was able to provide a sufficient analgesic effect for Total Abdominal Hysterectomy surgery, giving our patient the opportunity of early ambulation and avoiding opioids side effects especially the respiratory adverse effect.

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Ultrasound-Guided Anterior Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Related Side Effects in Patients Undergoing Total Hip Replacement Arthroplasty: A Propensity Score-Matched Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10204632 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4632

Author(s):

Yeon-Ju Kim ◽

Hyung-Tae Kim ◽

Ha-Jung Kim ◽

Pil-Whan Yoon ◽

Ji-In Park ◽

...

Keyword(s):

Side Effects ◽

Propensity Score ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Opioid Consumption ◽

Ultrasound Guided ◽

Pain Scores ◽

Quadratus Lumborum Block ◽

Replacement Arthroplasty ◽

Quadratus Lumborum

Quadratus lumborum block (QLB) has been shown to be effective for pain relief after hip surgery. This study evaluated the efficacy of ultrasound-guided anterior QLB in pain control after total replacement hip arthroplasty (TRHA). A total of 115 patients receiving anterior QLB were propensity score-matched with 115 patients who did not receive the block. The primary outcome was opioid consumption at 24, 24–48, and 48 postoperative hours. Secondary outcomes included pain scores at the post-anesthesia care unit (PACU), 8, 16, 24, 32, 40, and 48 h length of hospital stay, time to first ambulation, and the incidence of opioid-related side effects. Postoperative opioid consumption 48 h after surgery was significantly lower in the QLB group. Resting, mean, worst, and the difference of resting pain scores compared with preoperative values were significantly lower in the QLB group during the 48 postoperative hours. The length of hospital stay was shorter in the QLB group. The incidence of postoperative nausea and vomiting was significantly lower in the QLB group during the 48 postoperative hours, except at the PACU. This study suggests that anterior QLB provides effective postoperative analgesia for patients undergoing THRA performed using the posterolateral approach.

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