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The effectiveness of the intramuscular quadratus lumborum block in postoperative analgesia after cesarean section with vertical incision: a randomized, double-blinded placebo-controlled study

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Abstract

Purpose

Quadratus lumborum block (QLB) has recently been used for postoperative analgesia after abdominal surgery. Although there are several approaches to QLB, the effectiveness of intramuscular QLB (QLBi) remains controversial. The aim of the present study was to examine the effectiveness of QLBi for postoperative analgesia after cesarean section with a vertical midline incision.

Methods

In this single-center, randomized, double-blinded placebo-controlled study, 36 women who were scheduled for elective cesarean section were randomly divided into a QLBi group (n = 18) and a placebo group (n = 18). In both groups, spinal anesthesia was performed with 10–11 mg hyperbaric bupivacaine and 15 µg fentanyl. After the surgery, in the QLBi group, 0.4 mL/kg of 0.25% ropivacaine was injected into the bilateral quadratus lumborum muscle under ultrasound guidance (the total volume was 0.8 mL/kg). In the placebo group, instead of ropivacaine, the subjects were injected with the same amount of normal saline. The primary outcome measure was elapsed time to first analgesic use from the QLBi block after cesarean section.

Results

The data from all 36 patients were analyzed. There were no significant differences between the QLBi and placebo groups regarding elapsed time to first postoperative analgesic use [mean 230 (standard deviation 103) vs 194 (89) min; 95% confidence interval − 101 to 30; p = 0.27].

Conclusions

QLBi with the concentration and amount of local anesthetic used in the present study was clinically slightly effective, and the effect was limited for postoperative analgesia after cesarean section.

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Data availability statement

Data are available upon reasonable request.

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Acknowledgements

The authors would like to thank the gynecology ward staff and operating room staff of Aidu Chuo Hospital, Aizuwakamatsu, Japan, who followed the patients intra-/post-operatively, and cooperated with the present study.

Funding

The authors have no sources of funding to declare for this manuscript.

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Authors and Affiliations

  1. Department of Anesthesiology, Aidu Chuo Hospital, 1-1, Tsuruga-machi, Aizuwakmatsu, Fukushima, 965-8611, Japan

    Keisuke Yoshida, Shiori Tanaka & Kazuhiro Watanabe

  2. Department of Anesthesiology, Fukushima Medical University, 1, Hikariga-oka, Fukushima, Fukushima, 960-1297, Japan

    Keisuke Yoshida, Shiori Tanaka, Shinju Obara & Masahiro Murakawa

Authors
  1. Keisuke Yoshida
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  2. Shiori Tanaka
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  3. Kazuhiro Watanabe
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  4. Shinju Obara
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  5. Masahiro Murakawa
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Contributions

KY designed the study, obtained written consent from the patients, conducted intraoperative management, and prepared the manuscript. ST and KW contributed to the coordination of the study, analysis of data, and assisted in the preparation of the manuscript. SO helped to design the study and analysis of data. MM helped to draft the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Keisuke Yoshida.

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Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

This study was approved by the Ethics Committee of Aidu Chuo Hospital (approval number: 1901, Aizuwakamatsu, Japan).

Informed consent

Written informed consent was obtained from all individual participants included in the study.

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Yoshida, K., Tanaka, S., Watanabe, K. et al. The effectiveness of the intramuscular quadratus lumborum block in postoperative analgesia after cesarean section with vertical incision: a randomized, double-blinded placebo-controlled study. J Anesth 34, 849–856 (2020). https://doi.org/10.1007/s00540-020-02829-0

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  • DOI: https://doi.org/10.1007/s00540-020-02829-0

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