The analgesic efficacy of quadratus lumborum block in caesarean delivery: a meta-analysis and trial sequential analysis

Narinder P. Singh, Jeetinder K. Makkar, Anuradha Borle, David Monks, Basavana Gouda Goudra, Andres Zorrilla-Vaca, Preet Mohinder Singh

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Purpose: Quadratus lumborum block (QLB) has recently gained popularity for postoperative analgesia after cesarean delivery (CD) as it provides both visceral and somato-sensory blockade of the abdomen. Aim of this meta-analysis was to evaluate the analgesic potential of QLB after CD. Methods: Electronic database from inception to December 2019 was searched systematically for randomized-controlled trials comparing QLB with injection of inactive solution in women undergoing CD. Primary outcome was consumption of morphine at 24 h. Morphine consumption at 48 h, dynamic and static pain scores at various time intervals were the secondary outcomes studied. Results: Seven trials met the inclusion criteria. Morphine consumption was reduced significantly with QLB in comparison to sham or no block at 24 h (mean difference [MD] − 9.84 mg; 95% confidence interval [CI] − 18.16, − 0.50; p = 0.04; I2 = zero). Adequate “information size” for above outcome was confirmed with trial sequential analysis, ruling out any possibility of a false-positive result. QLB significantly reduced pain scores at rest (MD − 1.13; 95% CI − 1.75, − 0.56; p = 0.00) and on movement (MD − 1.48; 95% CI − 2.5, − 0.46; p = 0.01) at 6 h. However, statistically significant difference in pain scores persisted only for dynamic pain at 24 h (MD − 0.55; 95% CI − 1.04, − 0.06; p = 0.03). QLB does not provide any additional analgesic benefit to the parturient receiving intrathecal morphine. Conclusion: QLB significantly reduces opioid requirements in CD and may have analgesic effects lasting 24 h.

Original languageEnglish
Pages (from-to)814-824
Number of pages11
JournalJournal of Anesthesia
Volume34
Issue number6
DOIs
StatePublished - Dec 2020

Keywords

  • Analgesia
  • Cesarean delivery
  • Morphine
  • Postoperative pain
  • Quadratus lumborum block

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