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

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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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References

  1. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The increasing trend in cesarean section rates: global, regional and national estimates: 1990–2014. PLoS One. 2016;11:1–12.

    Article  Google Scholar 

  2. McDonnell NJ, Keating ML, Muchatuta NA, Pavy TJ, Paech MJ. Analgesia after cesarean delivery. Anaesth Intensive Care. 2009;37:539–51.

    Article  CAS  Google Scholar 

  3. Kerai S, Saxena KN, Taneja B. Post-caesarean analgesia: what is new? Indian J Anaesth. 2017;61:200–14.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Chin KJ, McDonnell JG, Carvalho B, Sharkey A, Pawa A, Gadsden J. Essentials of our current understanding: abdominal wall blocks. Reg Anesth Pain Med. 2017;42:133–83.

    Article  Google Scholar 

  5. Blanco R, Ansari T, Riad W, Shetty N. Quadratus lumborum block versus transversus abdominis plane block for postoperative pain after cesarean delivery: a randomized controlled trial. Reg Anesth Pain Med. 2016;41:757–62.

    Article  CAS  Google Scholar 

  6. Elsharkawy H, El-Boghdadly K, Barrington M. Quadratus lumborum block: anatomical concepts, mechanisms, and techniques. Anesthesiology. 2019;130:322–35.

    Article  Google Scholar 

  7. Higgins JP, Altman DG, Gotzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    Article  Google Scholar 

  8. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

    Article  Google Scholar 

  9. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13.

    Article  Google Scholar 

  10. Nielsen S, Degenhardt L, Hoban B, Gisev N. Comparing opioids: a guide to estimating oral morphine equivalents (OME) in research. Technical report. Sydney: National Drug and Alcohol Research Centre, University of NSW; 2014.

    Google Scholar 

  11. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, Emberson JR, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT. RoB 2: a revised tool for assessing risk of bias in randomized trials. BMJ. 2019;28(366):l4898.

    Article  Google Scholar 

  12. GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. McMaster University, 2015 (developed by Evidence Prime, Inc.). Available from /react-text gradepro.org react-text: 61.

  13. Tamura T, Yokota S, Ando M, Kubo Y, Nishiwaki K. A triple-blinded randomized trial comparing spinal morphine with posterior quadratus lumborum block after cesarean section. Int J Obstet Anesth. 2019;40:32–8 (Erratum in Int J Obstet Anesth. 2020; 41:129–30).

    Article  CAS  Google Scholar 

  14. Salama ER. Ultrasound guided bilateral quadratus lumborum block vs. intrathecal morphine for postoperative analgesia after cesarean section: a randomised controlled trial. Korean J Anesth. 2020;73:121–8.

    Article  CAS  Google Scholar 

  15. Hansen CK, Dam M, Steingrimsdottir GE, Laier GH, Lebech M, Poulsen TD, Chan VWS, Wolmarans M, Bendtsen TF, Børglum J. 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. Reg Anesth Pain Med. 2019.

  16. Mieszkowski MM, Mayzner-Zawadzka E, Tuyakov B, Mieszkowska M, Żukowski M, Waśniewski T, Onichimowski D. Evaluation of the effectiveness of the Quadratus Lumborum Block type I using ropivacaine in postoperative analgesia after a cesarean section—a controlled clinical study. Ginekol Pol. 2018;89:89–96.

    Article  Google Scholar 

  17. Krohg A, Ullensvang K, Rosseland LA, Langesæter E, Sauter AR. The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery: a randomized clinical trial. Anesth Analg. 2018;126:559–65 (Erratum in Anesth Analg 2019; 128:e18).

    Article  Google Scholar 

  18. Blanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative pain after cesarean section: a randomised controlled trial. Eur J Anaesth. 2015;32:812–8.

    Article  Google Scholar 

  19. Irwin R, Stanescu S, Buzaianu C, Rademan M, Roddy J, Gormley C, Tan T. Quadratus lumborum block for analgesia after caesarean section: a randomized controlled trial. Anaesthesia. 2020;75:89–95.

    Article  CAS  Google Scholar 

  20. Blanco R. TAP block under ultrasound guidance: the description of a ’non pops technique’. Reg Anesth Pain Med. 2007;32:130.

    Google Scholar 

  21. Champaneria R, Shah L, Wilson MJ, Daniels JP. Clinical effectiveness of transversus abdominis plane (TAP) blocks for pain relief after cesarean section: a meta-analysis. Int J Obstet Anesth. 2016;28:45–60.

    Article  CAS  Google Scholar 

  22. Rincón C, Moreno DA, Moore A. Erector spinae plane block for post-cesarean delivery analgesia. Int J Obstet Anesth. 2020;41:120–2.

    Article  Google Scholar 

  23. Verma K, Malawat A, Jethava D, Jethava DD. Comparison of transversus abdominis plane block and quadratus lumborum block for post-caesarean section analgesia: a randomised clinical trial. Indian J Anaesth. 2019;63:820–6.

    Article  Google Scholar 

  24. Wikner M. Unexpected motor weakness following quadratus lumborum block for gynaecological laparoscopy. Anaesthesia. 2017;72:230–2.

    Article  CAS  Google Scholar 

  25. Ueshima H, Hiroshi O. Incidence of lower-extremity muscle weakness after quadratus lumborum block. J Clin Anesth. 2018;44:104.

    Article  Google Scholar 

  26. El-Boghdadly Kariem, Pawa Amit. Ki Jinn Chin. Local anesthetic systemic toxicity: current perspectives Local Reg Anesth. 2018;11:35–44.

    CAS  PubMed  Google Scholar 

Download references

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Authors and 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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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

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