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The analgesic efficacy of quadratus lumborum block in caesarean delivery: a meta-analysis and trial sequential analysis

Journal of Anesthesia volume 34, pages 814–824 (2020)Cite this article

Abstract

Purpose

Quadratus lumborum block (QLB) has recently gained popularity for postoperative analgesia after cesarean delivery (CD) as it provides both visceral and somato-sensory blockade of the abdomen. Aim of this meta-analysis was to evaluate the analgesic potential of QLB after CD.

Methods

Electronic database from inception to December 2019 was searched systematically for randomized-controlled trials comparing QLB with injection of inactive solution in women undergoing CD. Primary outcome was consumption of morphine at 24 h. Morphine consumption at 48 h, dynamic and static pain scores at various time intervals were the secondary outcomes studied.

Results

Seven trials met the inclusion criteria. Morphine consumption was reduced significantly with QLB in comparison to sham or no block at 24 h (mean difference [MD] − 9.84 mg; 95% confidence interval [CI] − 18.16, − 0.50; p = 0.04; I2 = zero). Adequate “information size” for above outcome was confirmed with trial sequential analysis, ruling out any possibility of a false-positive result. QLB significantly reduced pain scores at rest (MD − 1.13; 95% CI − 1.75, − 0.56; p = 0.00) and on movement (MD − 1.48; 95% CI − 2.5, − 0.46; p = 0.01) at 6 h. However, statistically significant difference in pain scores persisted only for dynamic pain at 24 h (MD − 0.55; 95% CI − 1.04, − 0.06; p = 0.03). QLB does not provide any additional analgesic benefit to the parturient receiving intrathecal morphine.

Conclusion

QLB significantly reduces opioid requirements in CD and may have analgesic effects lasting 24 h.

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Author information

Affiliations

  1. Department of Anaesthesia, MM(DU), Mullana, Ambala, India

    Narinder P. Singh

  2. Department of Anaesthesia and Intensive Care, PGIMER, Sector 12, Chandigarh, 160012, India

    Jeetinder K. Makkar

  3. Department of Anesthesia, Washington University in Saint Louis, Saint Louis, MO, USA

    Anuradha Borle, David Monks & Preet Mohinder Singh

  4. Department of Anesthesia, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Basavana Gouda Goudra

  5. Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA

    Andres Zorrilla-Vaca

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  1. Narinder P. Singh
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  2. Jeetinder K. Makkar
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  4. David Monks
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  5. Basavana Gouda Goudra
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  6. Andres Zorrilla-Vaca
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  7. Preet Mohinder Singh
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Correspondence to Jeetinder K. Makkar.

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Singh, N.P., Makkar, J.K., Borle, A. et al. The analgesic efficacy of quadratus lumborum block in caesarean delivery: a meta-analysis and trial sequential analysis. J Anesth 34, 814–824 (2020). https://doi.org/10.1007/s00540-020-02822-7

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  • DOI: https://doi.org/10.1007/s00540-020-02822-7

Keywords

  • Cesarean delivery
  • Quadratus lumborum block
  • Morphine
  • Analgesia
  • Postoperative pain