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Quadratus lumborum block for postoperative analgesia after cesarean delivery: a systematic review and meta-analysis

  • M. Xu
    Affiliations
    Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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  • Y Tang
    Affiliations
    Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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  • J. Wang
    Affiliations
    Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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  • J. Yang
    Correspondence
    Correspondence to: J. Yang, Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People’s Republic of China.
    Affiliations
    Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Published:February 20, 2020DOI:https://doi.org/10.1016/j.ijoa.2020.02.005

      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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      References

        • Leung A.Y.
        Postoperative pain management in obstetric anesthesia-new challenges and solutions.
        J Clin Anesth. 2004; 16: 57-65
        • Declercq E.
        • Cunningham D.K.
        • Johnson C.
        • Sakala C.
        Mothers' reports of postpartum pain associated with vaginal and cesarean deliveries: results of a national survey.
        Birth. 2008; 35: 16-24
        • Gadsden J.
        • Hart S.
        • Santos A.C.
        Post-cesarean delivery analgesia.
        Anesth Analg. 2005; 101: S62-S69
        • Ueshima H.
        • Otake H.
        • Lin J.A.
        Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques.
        Biomed Res Int. 2017; 2017: 2752876
        • Blanco R.
        • Ansari T.
        • Girgis E.
        Quadratus lumborum block for postoperative pain after caesarean section A randomised controlled trial.
        Eur J Anaesthesiol. 2015; 32: 812-818
        • 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: 757-762
        • Murouchi T.
        • Iwasaki S.
        • Yamakage M.
        Quadratus lumborum block: Analgesic effects and chronological ropivacaine concentrations after laparoscopic surgery.
        Reg Anesth Pain Med. 2016; 41: 146-150
        • Abdallah F.W.
        • Halpern S.H.
        • Margarido C.B.
        Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis.
        Br J Anaesth. 2012; 109: 679-687
        • Champaneria R.
        • Shah L.
        • Wilson M.J.
        • Daniels J.P.
        Clinical effectiveness of transversus abdominis plane (TAP) blocks for pain relief after caesarean section: a meta-analysis.
        Int J Obstet Anesth. 2016; 28: 45-60
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
        J Clin Epidemiol. 2009; 62: e1-e34
        • Jadad A.R.
        • Moore R.A.
        • Carroll D.
        • et al.
        Assessing the quality of reports of randomized clinical trials: is blinding necessary?.
        Control Clin Trials. 1996; 17: 1-12
        • Higgins J.P.
        • Altman D.G.
        • Gotzsche P.C.
        • et al.
        The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343d5928
        • Higgins J.P.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Luo D.
        • Wan X.
        • Liu J.
        • Tong T.
        Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range.
        Stat Methods Med Res. 2018; 27: 1785-1805
        • Wan X.
        • Wang W.
        • Liu J.
        • Tong T.
        Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.
        BMC Med Res Methodol. 2014; 14: 135
        • Knotkova H.
        • Fine P.G.
        • Portenoy R.K.
        Opioid rotation: the science and the limitations of the equianalgesic dose table.
        J Pain Symptom Manage. 2009; 38: 426-439
        • Nelson K.A.
        • Glare P.A.
        • Walsh D.
        • Groh E.S.
        A prospective, within-patient, crossover study of continuous intravenous and subcutaneous morphine for chronic cancer pain.
        J Pain Symptom Manage. 1997; 13: 262-267
        • Jylli L.
        • Lundeberg S.
        • Langius-Eklof A.
        • Olsson G.L.
        Comparison of the analgesic efficacy of ketobemidone and morphine for management of postoperative pain in children: a randomized, controlled study.
        Acta Anaesthesiol Scand. 2004; 48: 1256-1259
        • Atkins D.
        • Briss P.A.
        • Eccles M.
        • et al.
        Systems for grading the quality of evidence and the strength of recommendations II: pilot study of a new system.
        BMC Health Serv Res. 2005; 5: 25
        • Krohg A.
        • Ullensvang K.
        • Rosseland L.A.
        • Langesæter E.
        • Sauter A.R.
        The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery: a randomized clinical trial.
        Anesth Analg. 2018; 126: 559-565
        • Mieszkowski M.M.
        • Mayzner-Zawadzka E.
        • Tuyakov B.
        • et al.
        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
        • Li G.
        • Mamat R.
        • Gai D.
        Postoperative analgesia efficacy of quadratus lumborum block versus transversus abdominis plane block in patients undergoing caesarean section.
        Int J Anesth Resus. 2018; 39: 338-340
        • Shan T.
        • Meng Q.
        • Shi L.
        • Bao H.
        Effect of ultrasound-guided quadratus lumborum block on efficacy of postoperative analgesia after caesarean section.
        Chin J Anesthesiol. 2018; 38: 435-438
        • Yu G.
        • Jin S.
        • Li H.
        • Wang Z.
        Ultrasound-guided quadratus lumborum block versus local infiltration for postoperative pain after lower segmental Cesarean section.
        J Pract Med. 2018; 34: 2567-2570
        • Zhang L.
        • Lin X.
        • Zhang H.
        • Yang D.
        • Lin G.
        • Huang Z.
        Effect of ultrasound-guided quadratus lumborum block on postoperative analgesia in parturient woman undergoing caesarean delivery.
        J Hebei Med Univ. 2018; 39: 1053-1057
        • Salama E.R.
        Ultrasound guided bilateral quadratus lumborum block vs. intrathecal morphine for postoperative analgesia after cesarean section: a randomised controlled trial.
        Korean J Anesthesiol. 2020; 73: 121-128
        • Hansen C.K.
        • Dam M.
        • Steingrimsdottir G.E.
        • et al.
        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 July 14. 2019; https://doi.org/10.1136/rapm-2019-100540
        • 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: 32-38
        • Guo M.
        • Lei B.
        • He S.
        • Deng X.
        • Wang L.
        Comparison of ultrasound-guided quadratus lumborum block with iliohypogastric/ilioinguinal nerve block for postoperative pain after cesarean section.
        J Pain Clin J. 2019; 15: 123-128
        • McDonnell N.J.
        • Keating M.L.
        • Muchatuta N.A.
        • Pavy T.J.
        • Paech M.J.
        Analgesia after caesarean delivery.
        Anaesth Intensive Care. 2009; 37: 539-551
        • Elsharkawy H.
        • El-Boghdadly K.
        • Barrington M.
        Quadratus lumborum block: anatomical concepts, mechanisms, and techniques.
        Anesthesiology. 2019; 130: 322-335
        • Irwin R.
        • Stanescu S.
        • Buzaianu C.
        • et al.
        Quadratus lumborum block for analgesia after caesarean section: a randomised controlled trial.
        Anaesthesia. 2020; 75: 89-95
        • Spence N.Z.
        • Olszynski P.
        • Lehan A.
        • Horn J.L.
        • Webb C.A.
        Quadratus lumborum catheters for breast reconstruction requiring transverse rectus abdominis myocutaneous flaps.
        J Anesth. 2016; 30: 506-509
        • Elsharkawy H.
        Quadratus lumborum block with paramedian sagittal oblique (subcostal) approach.
        Anaesthesia. 2016; 71: 241-242
        • Carline L.
        • McLeod G.A.
        • Lamb C.
        A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks.
        Br J Anaesth. 2016; 117: 387-394
        • Yang H.M.
        • Park S.J.
        • Yoon K.B.
        • Park K.
        • Kim S.H.
        Cadaveric evaluation of different approaches for quadratus lumborum blocks.
        Pain Res Manag. 2018; 2018: 2368930
        • Elsharkawy H.
        • El-Boghdadly K.
        • Kolli S.
        • et al.
        Injectate spread following anterior sub-costal and posterior approaches to the quadratus lumborum block: a comparative cadaveric study.
        Eur J Anaesthesiol. 2017; 34: 587-595
        • Kang W.
        • Lu D.
        • Yang X.
        • et al.
        Postoperative analgesic effects of various quadratus lumborum block approaches following cesarean section: a randomized controlled trial.
        J Pain Res. 2019; 12: 2305-2312