Quadratus Lumborum and Transversus Abdominis Plane Blocks and Their Impact on Acute and Chronic Pain in Patients after Cesarean Section: A Randomized Controlled Study

Michał Borys, Aleksandra Zamaro, Beata Horeczy, Ewa Gęszka, Marek Janiak, Piotr Węgrzyn, Mirosław Czuczwar, Paweł Piwowarczyk, Michał Borys, Aleksandra Zamaro, Beata Horeczy, Ewa Gęszka, Marek Janiak, Piotr Węgrzyn, Mirosław Czuczwar, Paweł Piwowarczyk

Abstract

Background: Severe postoperative pain is a significant problem after cesarean sections.

Methods: This study was a randomized, controlled trial of 105 patients conducted in two hospitals. All patients were anesthetized spinally for elective cesarean section. Each participant was randomly allocated to one of three study groups: the quadratus lumborum block (QLB) group, the transversus abdominis plane block (TAPB) group, or the control (CON) group. The primary outcome of this study determined acute pain intensity on the visual analog scale (VAS). The secondary outcomes determined morphine consumption and chronic pain evaluation according to the Neuropathic Pain Symptom Inventory (NPSI) after hospital discharge.

Results: At rest, the pain intensity was significantly higher in the CON group than in the QLB and TAPB groups at hours two and eight. Upon activity, the pain in the control subjects was more severe than in the QLB and TAPB groups in three and two of five measurements, respectively. Moreover, morphine consumption was significantly lower in the QLB (9 (5-10)) and TAPB (10 (6-14)) groups than in the CON (16 (11-19)) group. Persistent postoperative pain was significantly lower in the QLB group than in the CON group at months one and six following hospital discharge.

Conclusions: Both the QLB and TAPB can improve pain management after cesarean delivery. Moreover, the QLB might reduce the severity of persistent postoperative pain months after cesarean section.

Trial registration: ClinicalTrials.gov NCT03244540.

Keywords: Neuropathic Pain Symptom Inventory; patient-controlled analgesia; quadratus lumborum block; transversus abdominis plane block; visual analog scale.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Ultrasound-guided quadratus lumborum block.
Figure 2
Figure 2
Study flowchart.
Figure 3
Figure 3
Morphine consumption. The figure presents morphine consumption via PCA pumps during the first postoperative occurrence of pain. Results are presented as medians and interquartile ranges. * indicates statistical significance, CON > QLB, and TAPB. CON denotes the control group, PCA denotes patient-controlled analgesia, QLB denotes the quadratus lumborum block group, and TAPB denotes the transversus abdominis plane block group.

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Source: PubMed

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