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Comparative efficacy of quadratus lumborum type-II and erector spinae plane block in patients undergoing caesarean section under spinal anaesthesia: a randomised controlled trial

Published:December 06, 2022DOI:https://doi.org/10.1016/j.ijoa.2022.103614

      Highlights

      • Quadratus lumborum type-II and erector spinae plane block provide effective analgesia post-caesarean.
      • A randomised controlled trial comparing these two blocks.
      • There was no significant difference in fentanyl consumption between the blocks.

      Abstract

      Background

      Quadratus lumborum and erector spinae plane blocks have been used to provide analgesia in patients undergoing thoracic or abdominal surgeries. Our study compared the analgesic efficacy of the quadratus lumborum type-II block (QLB-II) and the erector spinae plane block (ESPB) in parturients who underwent caesarean section under spinal anaesthesia.

      Methods

      Fifty-two patients with comparable demographic profiles were randomised into two groups, QLB-II (n = 26) and ESPB (n = 26). After the surgery, patients received either ultrasound-guided QLB-II or ESPB using 0.25% bupivacaine 0.3 mL/kg. Comparison of analgesic efficacy was in terms of fentanyl consumption (primary outcome), pain scores, incidence of complications in the 24-h postoperative period, and quality of recovery (QoR-15) on postoperative days one and two, and day of discharge.

      Results

      There was no significant difference in cumulative number of fentanyl doses (W = 349.000, P = 0.840), numerical rating score at rest (P = 0.648) or with movement (P = 0.520), QoR-15 scores on postoperative day one (P = 0.549), day two (P = 0.927) or day of discharge (P = 0.676).

      Conclusion

      We concluded that patients who underwent QLB-II or ESPB reported similar analgesic efficacy, complications, and quality of recovery in the postoperative period.

      Keywords

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      References

        • Todman D.
        A history of caesarean section: from ancient world to the modern era.
        Aust N Z J Obstet Gynaecol. 2007; 47: 357-361https://doi.org/10.1111/j.1479-828X.2007.00757.x
        • Macones G.A.
        • Caughey A.B.
        • Wood S.L.
        • et al.
        Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3).
        Am J Obstet Gynecol. 2019; 221: 247https://doi.org/10.1016/j.ajog.2019.04.012
        • Carvalho B.
        • Butwick A.J.
        Postcesarean delivery analgesia.
        Best Pract Res Clin Anaesthesiol. 2017; 31: 69-79https://doi.org/10.1016/j.bpa.2017.01.003
        • Elsharkawy H.
        • El-Boghdadly K.
        • Barrington M.
        Quadratus Lumborum Block: Anatomical Concepts, Mechanisms, and Techniques.
        Anesthesiology. 2019; 130: 322-335https://doi.org/10.1097/ALN.0000000000002524
        • 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: 757-762https://doi.org/10.1097/AAP.0000000000000495
        • Luis-Navarro J.C.
        • Seda-Guzmán M.
        • Luis-Moreno C.
        • Chin K.J.
        Erector spinae plane block in abdominal surgery: Case series.
        Indian J Anaesth. 2018; 62: 549-554https://doi.org/10.4103/ija.IJA_57_18
        • Willard F.H.
        • Vleeming A.
        • Schuenke M.D.
        • Danneels L.
        • Schleip R.
        The thoracolumbar fascia: anatomy, function and clinical considerations.
        J Anat. 2012; 221: 507-536https://doi.org/10.1111/j.1469-7580.2012.01511.x
        • Hamed M.A.
        • Yassin H.M.
        • Botros J.M.
        • Abdelhady M.A.
        Analgesic efficacy of erector spinae plane block compared with intrathecal morphine after elective cesarean section: A prospective randomized controlled study.
        J Pain Res. 2020; 13: 597-604https://doi.org/10.2147/JPR.S242568
        • Blanco R.
        • Ansari T.
        • Girgis E.
        Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial.
        Eur J Anaesthesiol. 2015; 32: 812-818https://doi.org/10.1097/EJA.0000000000000299
        • 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: 32-38https://doi.org/10.1016/j.ijoa.2019.06.008
        • Xu M.
        • Tang Y.
        • Wang J.
        • Yang J.
        Quadratus lumborum block for postoperative analgesia after cesarean delivery: a systematic review and meta-analysis.
        Int J Obstet Anesth. 2020; 42: 87-98https://doi.org/10.1016/j.ijoa.2020.02.005
        • Boules M.L.
        • Goda A.S.
        • Abdelhady M.A.
        • Abu El-Nour Abd El-Azeem S.A.
        • Hamed M.A.
        Comparison of analgesic effect between erector spinae plane block and transversus abdominis plane block after elective cesarean section: A prospective randomized single-blind controlled study.
        J Pain Res. 2020; 13: 1073-1080https://doi.org/10.2147/JPR.S253343
        • Malawat A.
        • Verma K.
        • Jethava D.
        • Jethava D.D.
        Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: A prospective randomized comparative study.
        J Anaesthesiol Clin Pharmacol. 2020; 36: 201-206https://doi.org/10.4103/joacp.JOACP_116_19
        • Ribeiro Junior I.D.V.
        • Carvalho V.H.
        • Brito L.G.O.
        Erector spinae plane block for analgesia after cesarean delivery: a systematic review with meta-analysis.
        Braz J Anesthesiol. 2022; 72: 506-515https://doi.org/10.1016/j.bjane.2021.09.015
        • Aygun H.
        • Kavrut Ozturk N.
        • Pamukcu A.S.
        • et al.
        Comparison of ultrasound guided erector spinae plane block and quadratus lumborum block for postoperative analgesia in laparoscopic cholecystectomy patients; a prospective randomized study.
        J Clin Anesth. 2020; 62: 109696https://doi.org/10.1016/j.jclinane.2019.109696
        • Tulgar S.
        • Kose H.C.
        • Selvi O.
        • et al.
        Comparison of ultrasound-guided lumbar erector spinae plane block and transmuscular quadratus lumborum block for postoperative analgesia in hip and proximal femur surgery: A prospective randomized feasibility study.
        Anesth Essays Res. 2018; 12: 825-831https://doi.org/10.4103/aer.AER_142_18
        • Aksu C.
        • Şen M.C.
        • Akay M.A.
        • Baydemir C.
        • Gürkan Y.
        Erector spinae plane block vs quadratus lumborum block for pediatric lower abdominal surgery: A double blinded, prospective, and randomized trial.
        J Clin Anesth. 2019; 57: 24-28https://doi.org/10.1016/j.jclinane.2019.03.006
        • Demumieux F.
        • Ludes P.O.
        • Diemunsch P.
        • et al.
        Validation of the translated Quality of Recovery-15 questionnaire in a French-speaking population.
        Br J Anaesth. 2020; 124: 761-767https://doi.org/10.1016/j.bja.2020.03.011
        • Kleif J.
        • Gögenur I.
        Severity classification of the quality of recovery-15 score- an observational study.
        J Surg Res. 2018; 225: 101-107https://doi.org/10.1016/j.jss.2017.12.040
        • Yao Y.
        • Li H.
        • He Q.
        • et al.
        Efficacy of ultrasound-guided erector spinae plane block on postoperative quality of recovery and analgesia after modified radical mastectomy: randomized controlled trial.
        Reg Anesth Pain Med. 2020; 45: 5-9https://doi.org/10.1136/rapm-2019-100983
        • Sá M.
        • Cardoso J.M.
        • Reis H.
        • et al.
        Quadratus lumborum block: are we aware of its side effects? A report of 2 cases.
        Braz J Anesthesiol. 2018; 68: 396-399https://doi.org/10.1016/j.bjan.2017.04.023
        • Selvi O.
        • Tulgar S.
        Ultrasound guided erector spinae plane block as a cause of unintended motor block.
        Rev Esp Anestesiol Reanim (Engl Ed). 2018; 65: 589-592https://doi.org/10.1016/j.redare.2018.05.003