Introduction: The majority of women who have planned cesarean section receive spinal anesthesia for the procedure. Typically, spinal opioids are administered during the same time as a component of multimodal analgesia to provide pain relief in the 16 – 24 hours period postoperatively. The ultrasound-guided quadratus lumborum block is emerged as a new regional analgesic technique that blocks T5 – L1 nerve branches and has an evolving role in postoperative analgesia for lower abdominal surgeries and may be a potential alternative to spinal opioids. If found effective, it would give the advantage of a reduction in opioid associated adverse effects while providing similar quality of analgesia.
We performed bilateral ultrasound- guided quadratus lumborum block in 50 women who received a spinal anesthetic for an elective cesarean delivery and evaluated their NRS, post-operative opioids consumption and patient satisfaction the first 24 hours after the block.
In all 50 patients, there were no additional opioids consumption during the first 24 hours after the block. The Numeric Rating Scale (NRS) for pain was less than 4 in the first 24 hours. Women were all very satisfied with the quality of pain relief.
Discussion: Ultrasound-guided quadratus lumborum block may be a promising anesthetic adjuvant for post-cesarean analgesia. Randomized controlled trials are needed to compare the efficacy of the ultrasound-guided quadratus lumborum block with intrathecal opioids.
- Abdallah F.W., Halpern S. H.. Margarido C. B. Transversus abdominis Plane block for Postoperative analgesia after Caesarean delivery performed under spinal anesthesia? A systematic review and meta-analysis. British Journal of Anesthesia 109 (5): 679-87 (2012).
- Akerman M, Pejčić N2, Veličković I. A review of the Quadratus Lumborum Block and ERAS. Pe2018 Feb 26;5:44. doi: 10.3389/fmed.2018.00044. eCollection 2018.
- Ashok Jadon, Mayur Motka, Asit Kumar, Neelam Sinha. Postoperative Analgesia by Transmuscular Quadratus Lumborum Block Catheter. Journal of Anesthesia & Intensive Care Medicine, Volume 1 Issue 3- December 2016. DOI: 10.19080/JAICM.2016.01.555562.
- Blanco R, T.Ansari, W.Riad, N.Sheltty. (2016). Quandratus lumborum block versus transversus abdomonis plane block for postoperative pain after cesarean delivery. Regional Anesthesia and pain Medicine, 41(6): p.757-762.
- Blanco, Rafael; Ansari, Tarek; Girgis, Emad. Quadratus lumborum block for postoperative pain after cesarean section: A randomized controlled trial. European Journal of Anaesthesiology (EJA): November 2015 – Volume 32 – Issue 11 – p 812–818
- B∅rglum J,Moriggl B, Jensen K, Lonnqvist PA, Christensen AF, Sauter A, Bendsten TF. (2013). Ultrsound- guided Transmuscular Quandratus Lumborum Blockade. Br Anaesth, Online ISSN 1471-6771 – Print ISSN 0007-0912 http://bja.oxfordjournals.org/forum/topic/brjana_el%3b9919
- Carvalho R, Segura E, Loureiro MD, Assunção JP. Quadratus lumborum block in chronic painafter abdominal hernia repair: case report. Braz J Anesthesiol. 2016;67(1):107-109.
- Chakraborty A, Khemka R, Datta T. Ultrasound-guided truncal blocks: A new frontier in regional anaesthesia. Indian J Anaesth. 2016 Oct;60(10):703-711
- Hesham A Elsharkawy. Quadratus Lumborum Blocks. Advances in Anesthesia 35 (2017): 145-157
- Ilana Sebbag, Fatemah Qasem, Shalini Dhir. Ultrsound guided quadratus lumborum block for analgesia after cesarean delivery: case series. Rev Bras Anestesiol. 2017; 67(4):418-421
- Ishio J1, Komasawa N2, Kido H1, Minami T1. Evaluation of ultrasound-guided posterior quadratus lumborum block for postoperative analgesia after laparoscopic gynecologic surgery. J Clin Anesth. 2017 Sep;41:1-4.
- Michael T Wiisanen, Jeffrey W Hartwig, Chief Editor: Meda Raghavendra (Raghu). Transversus Abdominis Plane Block Periprocedural Care. Medscape, Updated: May, 31, 2018.
- Murouchi T. Quadratus Lumborum Block intrmuscular approachfor pediatric surgery. Acta Anesthesiologica Taiwanica. 2016, 54:00 p.m. 135-136
- Neal JM1Ultrasound-guided regional anesthesia and patient safety: Update of a evidence-based analysis. Reg Anesth Pain Med. 2016 Mar-Apr;41(2):195-204
- Öksüz G, Bilal B, Gürkan Y, Urfalioğlu A, Arslan M, Gişi G, Öksüz H. Quadratus Lumborum Block Versus Transversus Abdominis Plane Block in Children Undergoing Low Abdominal Surgery: A Randomized Controlled Trial. Reg Anesth Pain Med. 2017 Sep/Oct; 42(5):674-679
- Thi Mum Huynh, Emmanuel Marret and Francis Bonnet. Combination of dexamethasone and local anaesthetic solution in peripheral nerve blocks. A meta-analysis of randomised controlled trials. Eur J Anaesthesiol 2015; 32:751–758
- Ueshima H, Otake H, Lin JA. Ultrasound-Guided Quadratus Lumborum Block: An Updated Review of Anatomy and Techniques. Biomed Res Int. 2017; 2017:2752876. Epub 2017 Jan 3