DG Journal Club
BACKGROUND Quadratus lumborum blocks (QLB) are relatively novel regional anesthesia techniques, and the efficacy of all three types of QLB for postoperative analgesia in cesarean delivery (CD) has been demonstrated in separate studies. The aim of the present study is to compare the analgesic efficacy of the QLB-II and QLB-III blocks performed at the end of surgery in patients undergoing spinal anesthesia for CD.
METHODS We conducted a comparative, blinded, prospective, randomized, efficiency study. 80 patients scheduled for elective CD under spinal anesthesia were randomly allocated to receive either bilateral ultrasound-guided QLB-II or QLB-III block in a 1:1 ratio. The primary outcome was opioid consumption administered by a patient-controlled analgesia in the first 24 hours postoperatively. The secondary outcome of the study was pain intensity. Also, the time of first opioid requirement and the presence of nausea and vomiting were recorded.
RESULTS Morphine consumption was statistically significantly lower in the QLB-III group when compared to the QLB-II group at the 3 rd , 6 th , 12 th , and 24 th hours (p<0.001, p<0.001, p = 0.004, and p = 0.015, respectively). The QLB-III group showed significantly lower pain scores at rest at the 1 st , 3 rd , 6 th , 9 th , and 24 th hours after surgery (p<0.001, p<0.001, p<0.001, p = 0.007, and p<0.001, respectively). The QLB-III group also showed significantly lower pain score on movement at all measurement times (p<0.001).
CONCLUSIONS The analgesic efficacy of QLB-III was superior to QLB-II in patients who had undergone CD under spinal anesthesia without use of intrathecal opioids and postpartum NSAIDs.