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Quadratus lumborum block for postoperative pain after caesarean section : A randomised controlled trial . BACKGROUND Effective postoperative analgesia after caesarean section is important because it enables early ambulation and facilitates breast-feeding . Several case reports have shown that local anaesthetic injection around the quadratus lumborum muscle is effective in providing pain relief after various abdominal operations and in patients with chronic pain . The quadratus lumborum block ( QLB ) is performed in close proximity to the surface and uses a fascial compartment path to extend the distribution of local anaesthesia into the posterior abdominal wall and paravertebral space . This central effect can be of vital importance when managing the visceral pain after caesarean section . OBJECTIVE We hypothesised that the QLB after caesarean section can provide adequate pain relief as part of a multimodal approach . DESIGN Double-blind , randomised and controlled clinical trial . SETTING A single centre between June 2014 and December 2014 . PATIENTS Fifty patients who were American Society of Anesthesiologists physical status 1 or 2 , with normal singleton pregnancies with a gestation of at least 37 weeks , and scheduled for elective caesarean section under spinal anaesthesia , were enrolled into the study . They were randomly assigned to receive a QLB ( n = 25 ) with 0.125 % bupivacaine 0.2 ml kg⁻¹ ( Group 1 ) or a QLB ( n = 25 ) with 0.9 % Normal saline 0.2 ml kg⁻¹ ( Group 2 ) . MAIN OUTCOME MEASURES The primary outcome measure for the study was the morphine demands and doses delivered by a patient-controlled analgesia system at predetermined intervals ( 1 , 2 , 4 , 6 , 12 , 24 and 48 h ) after surgery . The secondary endpoints were visual analogue scale ( VAS ) for pain at rest and on movement ( dynamic ) , heart rate , blood pressure , pruritus , itching , nausea , vomiting and sedation . RESULTS The patients who received local anaesthetic used significantly less morphine than the control group ( P < 0.001 ) at 6 and 12 h , but not at 24 and 48 hours after caesarean section . The local anaesthetic group had significantly less morphine demand than the control group ( P < 0.001 ) 6 , 12 , 24 and 48 h after caesarean section . The VAS was significantly lower in the local anaesthetic group than the control group , including VAS for pain at rest at all times except 24 h after caesarean section , and VAS for pain on movement ( dynamic ) at all times . CONCLUSION The QLB after caesarean section was effective and provided satisfactory analgesia in combination with a typical postoperative analgesic regimen . TRIAL REGISTRATION ClinicalTrials.gov identifier : NCT02328378 .
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Intervention_Physical
lumborum block
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Intervention_Surgical
caesarean section
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Intervention_Surgical
caesarean
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Intervention_Physical
local anaesthetic injection
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Intervention_Physical
quadratus lumborum block
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Intervention_Physical
QLB
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Intervention_Pharmacological
bupivacaine
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Outcome_Pain
postoperative pain
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Outcome_Pain
visceral pain
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Outcome_Other
morphine demands and doses
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Outcome_Pain
visual analogue scale ( VAS ) for pain at rest and on movement ( dynamic )
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Outcome_Pain
heart rate
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Outcome_Pain
blood pressure
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Outcome_Pain
pruritus
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Outcome_Pain
itching
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Outcome_Other
used significantly
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Outcome_Other
anaesthetic group had
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Participant_Condition
postoperative pain after caesarean section :
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Participant_Condition
patients with chronic pain .
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Participant_Sample-size
Fifty
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Participant_Condition
Anesthesiologists
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Participant_Condition
elective caesarean section under spinal anaesthesia