A Randomized Study on Quadratus Lumborum and Transversus Abdominis Plane Blocks for Postoperative Pain Management After Cesarean Delivery

Document Type : Original Article

Authors

1 Department of Obstetrics and Gynecology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt.

2 Department of Anesthesiology, Intensive Care and Pain Medicine, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt.

Abstract

Background: Effective postoperative analgesia after caesarean section is crucial for early ambulation and quality of life. Quadratus lumborum [QL] block is gaining wide acceptance for pain control after lower abdominal surgery.
Aim of the study: The current work aimed to compare between transversus abdominis plane [TAP] block and Quadratus Lumborum Block [QLB] in patients undergoing elective cesarean delivery [CD] under spinal anesthesia.
Patients and Methods: The study included 200 patients who were divided randomly into two equal groups according to the type of anesthetic blocks [Ultrasound guided QLB and TAP block]. All underwent cesarean delivery using Pfannenstiel incision and subarachnoid anesthesia with 0.25% bupivacaine. Preoperatively all women were assessed clinically and by laboratory investigations. The visual analogue scale [VAS] was the proper method for postoperative pain assessment. Women demographics and preoperative hemodynamics were recorded. After the procedure, hemodynamics and pain assessment was continued on regular intervals. The time for first analgesic request, the total dose of analgesics and any complications were documented.
Results: QLB group had significantly lower pain score at 4 and 6 hours, and from 10 hours till the end of assessment duration. Both groups were comparable after surgery and at 2 hours. The heart rate and respiratory rate were significantly lower in the QLB than the TAB group. However, values were in the normal range. The time for the first analgesic request was significantly longer in QLB than TAP block [458.79±39.68 vs 262.75±30.92 minutes. The total dose of analgesics was significantly lower in QLB than TAPB. The somatic pain was reported by 17% and 45% in QLB and TAPB groups respectively.
Conclusion: The Quadratus lumborum block was a safe, reliable, and effective option for postoperative pain relief after elective caesarean delivery. QLB was superior to the TAP block for pain control and both were comparable as the rate of complications.

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