Highlights
- •12 studies were reviewed to assess the utility of quadratus lumborum block (QLB).
- •QLB can reduce opioid use and improve pain control after cesarean delivery.
- •QLB can provide effective analgesia when intrathecal morphine has not been used.
Abstract
Background
Quadratus lumborum block (QLB) can reduce pain and opioid consumption after cesarean
delivery. This systematic review investigated the effectiveness of QLB in reducing
postoperative opioid use and its effect on pain scores compared with other analgesic
methods after cesarean delivery.
Methods
Six medical databases were searched from their inception to August 2019. Trials were
eligible if parturients underwent cesarean delivery under spinal anesthesia (not epidural
or general anesthesia). The primary outcome was postoperative opioid consumption during
the first 24 and 48 h. Secondary outcomes included pain scores, patient satisfaction,
and side effects. The risk of bias was assessed using the Cochrane tool. Where possible,
meta-analytic techniques were used to synthesize data, presented as mean difference
with 95% confidence interval (CI).
Results
Twelve studies involving 904 patients were identified and analyzed. Opioid (intravenous
morphine) consumption was significantly reduced with QLB when compared with placebo
or no block during the first 24 h by 14.1 mg, (95% CI −20.8 to −7.5 mg) and 48 h by
20.8 mg, (95% CI −33.1 to −8.5 mg). Additionally, QLB significantly reduced 12-h pain
scores at rest and during movement. However, this difference disappeared at 24 and
48 h. There was insufficient evidence regarding postoperative opioid use or pain scores
with the use of QLB compared to intrathecal morphine.
Conclusions
The review findings show the superior analgesic effect of QLB when compared with systemic
opioids in reducing postoperative opioid consumption, when intrathecal morphine is
not administered.
Keywords
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Article info
Publication history
Published online: February 20, 2020
Accepted:
February 13,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
