Comparison of transversus abdominis plane block and quadratus lumborum block for post-caesarean section analgesia: A randomised clinical trial

Kalpana Verma, Aman Malawat, Durga Jethava, Dharam Das Jethava, Kalpana Verma, Aman Malawat, Durga Jethava, Dharam Das Jethava

Abstract

Background and aims: Effective post-operative analgesia after caesarean section (CS) is important because it facilitates early amelioration, ambulation and expedites breastfeeding. Quadratus lumborum (QL) block is an interfascial block providing effective visceral and somatic analgesia. We conducted this study to compare the analgesic efficacy of QL block and transversus abdominis plane (TAP) block after CS.

Methods: In this single hospital-based, prospective double-blind study, 60 patients scheduled for an elective CS between December 2018 and January 2019 were randomised to receive ultrasound-guided TAP block (n = 30) or QL block (n = 30) bilaterally with 0.2% ropivacaine postoperatively. The primary objective was to measure the time for rescue analgesic requirement and secondary objectives included the total number of analgesic dose required over a period of 72 hours and severity of post-operative pain assessment via visual analogue scale (VAS) score at rest and with movement. Statistical analysis was done using SPSS version 21. Data were compared using the Chi-square test and students' t-test.

Results: Time for rescue analgesic requirement was higher in the QL group than the TAP group (mean ± SD: 68.77 ± 1.74 h vs. 13.3 ± 1.21 h) (P < 0.001). The QL group had significantly less analgesic demand (P < 0.001) at 2, 4, 6, 12, 24, 36, 48 and 72 h post-CS. The VAS at rest and movement was significantly reduced in the QL group at all times.

Conclusion: The QL block provided prolonged and effective analgesia in comparison to TAP block up to 72 hours post-CS.

Keywords: Caesarean section; quadratus lumborum block; transversus abdominis plane block.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2019 Indian Journal of Anaesthesia.

Figures

Figure 1
Figure 1
(a) Ultrasound preinjection image of posterior approach of QL block. EO: External oblique muscle, IO: Internal oblique muscle, TA: Transverses abdominis, QL: Quadratus lumborum. (b) Ultrasound post-injection image of posterior approach of QL block. EO: External oblique muscle, IO: Internal oblique muscle, TA: Transverses abdominis, QL: Quadratus lumborum, LA: Local anaesthetic drug, and blue colored area: Deposition site of local anaesthetic
Figure 2
Figure 2
(a) Ultrasound preinjection image of posterior approach of TAP block. EO: External oblique muscle, IO: Internal oblique muscle, TA: Transverses abdominis, QL: Quadratus lumborum. (b) Ultrasound post-injection image of posterior approach of TAP block. EO: External oblique muscle, IO: Internal oblique muscle, TA: Transverses abdominis, QL: Quadratus lumborum, LA: Local anaesthetic drug, and blue colored area: Deposition site of local anaesthetic
Figure 3
Figure 3
Consort flow diagram. QL: Quadratus lumborum, TAP: Transversus abdominis plane
Figure 4
Figure 4
(a) Time for rescue analgesic requirement in hours. Group QL: Quadratus lumborum group, Group TAP: Transversus abdominis plane group, SD: Standard deviation. (b) Total number of analgesic dose in 72 hours. Group QL: Quadratus lumborum group, Group TAP: transversus abdominis plane group
Figure 5
Figure 5
(a) VAS at rest. QL: Quadratus lumborum, TAP: Transversus abdominis plane, SD: Standard deviation. (b) VAS at movement. QL: Quadratus lumborum, TAP: Transversus abdominis plane, SD: Standard deviation

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