open access

Vol 89, No 2 (2018)
ORIGINAL PAPERS Obstetrics
Published online: 2018-02-28
Get Citation

Evaluation of the effectiveness of the Quadratus Lumborum Block type I using ropivacaine in postoperative analgesia after a cesarean section — a controlled clinical study

Marcin Mieszko Mieszkowski, Ewa Mayzner-Zawadzka, Bułat Tuyakov, Marta Mieszkowska, Maciej Żukowski, Tomasz Waśniewski, Dariusz Onichimowski
DOI: 10.5603/GP.a2018.0015
·
Pubmed: 29512813
·
Ginekol Pol 2018;89(2):89-96.

open access

Vol 89, No 2 (2018)
ORIGINAL PAPERS Obstetrics
Published online: 2018-02-28

Abstract

Objectives: Quadratus Lumborum Block in contrast to Transversus Abdominis Plane Block contains a unique component which not only stops somatic pain but also inhibits visceral pain by spreading the local anesthetic to the paravertebral space. This study was designed to determine whether performing the Quadratus Lumborum Block type I in patients un­dergoing cesarean section would be associated with both decreased morphine consumption and decreased pain levels in the postoperative 48-hour period.

Material and methods: Sixty patients undergoing caesarean section under spinal anesthesia were randomly and equally assigned to one or other of two groups: QLB I (who received Bilateral Quadratus Lumborum Block type I with the use of 24 mL 0.375% ropivacaine per side) or a Control group. In both groups, on-demand morphine analgesia was administered postoperatively within the first 48 hours. The following were measured: the morphine consumption; the time elapsed from the C-section until the first dose of morphine; and the levels of pain intensity among patients in rest (numeral pain rating scale).

Results: There were no statistically significant demographic data differences between the QLB I and Control groups. The following significant differences were observed in the 48-hour postoperative period: morphine consumption was higher in the Control group (p = 0.000); the time elapsed from the C-section until the first dose of morphine was longer in QLB I group (p < 0.05); and the median of the pain numeric rating scale was higher in the Control group (p < 0.05).

Conclusions: Quadratus Lumborum Block type I significantly reduces morphine consumption and pain levels up to 48 hours postoperatively.

Abstract

Objectives: Quadratus Lumborum Block in contrast to Transversus Abdominis Plane Block contains a unique component which not only stops somatic pain but also inhibits visceral pain by spreading the local anesthetic to the paravertebral space. This study was designed to determine whether performing the Quadratus Lumborum Block type I in patients un­dergoing cesarean section would be associated with both decreased morphine consumption and decreased pain levels in the postoperative 48-hour period.

Material and methods: Sixty patients undergoing caesarean section under spinal anesthesia were randomly and equally assigned to one or other of two groups: QLB I (who received Bilateral Quadratus Lumborum Block type I with the use of 24 mL 0.375% ropivacaine per side) or a Control group. In both groups, on-demand morphine analgesia was administered postoperatively within the first 48 hours. The following were measured: the morphine consumption; the time elapsed from the C-section until the first dose of morphine; and the levels of pain intensity among patients in rest (numeral pain rating scale).

Results: There were no statistically significant demographic data differences between the QLB I and Control groups. The following significant differences were observed in the 48-hour postoperative period: morphine consumption was higher in the Control group (p = 0.000); the time elapsed from the C-section until the first dose of morphine was longer in QLB I group (p < 0.05); and the median of the pain numeric rating scale was higher in the Control group (p < 0.05).

Conclusions: Quadratus Lumborum Block type I significantly reduces morphine consumption and pain levels up to 48 hours postoperatively.

Get Citation

Keywords

quadratus lumborum block type I, ropivacaine, cesarean section, multimodal analgesia

About this article
Title

Evaluation of the effectiveness of the Quadratus Lumborum Block type I using ropivacaine in postoperative analgesia after a cesarean section — a controlled clinical study

Journal

Ginekologia Polska

Issue

Vol 89, No 2 (2018)

Pages

89-96

Published online

2018-02-28

DOI

10.5603/GP.a2018.0015

Pubmed

29512813

Bibliographic record

Ginekol Pol 2018;89(2):89-96.

Keywords

quadratus lumborum block type I
ropivacaine
cesarean section
multimodal analgesia

Authors

Marcin Mieszko Mieszkowski
Ewa Mayzner-Zawadzka
Bułat Tuyakov
Marta Mieszkowska
Maciej Żukowski
Tomasz Waśniewski
Dariusz Onichimowski

References (34)
  1. OECD Health Statistics 2014 - Frequently Requested Data. http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequently-requested-data.htm.
  2. Granot M, Lowenstein L, Yarnitsky D, et al. Postcesarean section pain prediction by preoperative experimental pain assessment. Anesthesiology. 2003; 98(6): 1422–1426.
  3. Strigo IA, Bushnell MC, Boivin M, et al. Psychophysical analysis of visceral and cutaneous pain in human subjects. Pain. 2002; 97(3): 235–246.
  4. Gadsden J, Hart S, Santos AC. Post-cesarean delivery analgesia. Anesth Analg. 2005; 101(5 Suppl): S62–S69.
  5. Karlström A, Engström-Olofsson R, Norbergh KG, et al. Postoperative pain after cesarean birth affects breastfeeding and infant care. J Obstet Gynecol Neonatal Nurs. 2007; 36(5): 430–440.
  6. Eisenach JC, Pan PH, Smiley R, et al. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain. 2008; 140(1): 87–94.
  7. Lavoie A, Toledo P. Multimodal postcesarean delivery analgesia. Clin Perinatol. 2013; 40(3): 443–455.
  8. Misiołek H, Cettler M, Woroń J, et al. The 2014 guidelines for post-operative pain management. Anaesthesiol Intensive Ther. 2014; 46(4): 221–244.
  9. Marhofer P, Willschke H, Greher M, et al. New perspectives in regional anesthesia: the use of ultrasound-past, present, and future. Can J Anesth. 2005; 52(S1): R28–R32.
  10. Abdallah FW, Laffey JG, Halpern SH, et al. Duration of analgesic effectiveness after the posterior and lateral transversus abdominis plane block techniques for transverse lower abdominal incisions: a meta-analysis. Br J Anaesth. 2013; 111(5): 721–735.
  11. Abdallah FW, Chan VW, Brull R. Transversus abdominis plane block: a systematic review. Reg Anesth Pain Med. 2012; 37(2): 193–209.
  12. Fusco P, Scimia P, Paladini G, et al. Transversus abdominis plane block for analgesia after Cesarean delivery. A systematic review. Minerva Anestesiol. 2015; 81(2): 195–204.
  13. Carney J, Finnerty O, Rauf J, et al. Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks. Anaesthesia. 2011; 66(11): 1023–1030.
  14. Blanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial. Eur J Anaesthesiol. 2015; 32(11): 812–818.
  15. Blanco R, Ansari T, Riad W, et al. Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Pain After Cesarean Delivery: A Randomized Controlled Trial. Reg Anesth Pain Med. 2016; 41(6): 757–762.
  16. Ueshima H, Otake H, Lin JA. Ultrasound-Guided Quadratus Lumborum Block: An Updated Review of Anatomy and Techniques. Biomed Res Int. 2017; 2017: 2752876.
  17. Weigl W, Bieryło A, Krzemień-Wiczyńska S, et al. [Comparative study of postoperative analgesia after intrathecal administration of bupivacaine with fentanyl or morphine for elective Caesarean section]. Anestezjol Intens Ter. 2009; 41(1): 28–32.
  18. Kanazi GE, Aouad MT, Abdallah FW, et al. The analgesic efficacy of subarachnoid morphine in comparison with ultrasound-guided transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg. 2010; 111(2): 475–481.
  19. Abouleish E, Rawal N, Rashad MN. The addition of 0.2 mg subarachnoid morphine to hyperbaric bupivacaine for cesarean delivery: a prospective study of 856 cases. Reg Anesth. 1991; 16(3): 137–140.
  20. Moore RA, McQuay HJ, Tomaszewski J, et al. Dexketoprofen/tramadol 25 mg/75 mg: randomised double-blind trial in moderate-to-severe acute pain after abdominal hysterectomy. BMC Anesthesiol. 2016; 16: 9.
  21. Baaj JM, Alsatli RA, Majaj HA, et al. Efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postcesarean section delivery analgesia--a double-blind, placebo-controlled, randomized study. Middle East J Anaesthesiol. 2010; 20(6): 821–826.
  22. Belavy D, Cowlishaw PJ, Howes M, et al. Ultrasound-guided transversus abdominis plane block for analgesia after Caesarean delivery. Br J Anaesth. 2009; 103(5): 726–730.
  23. Carney J, Lane J, Quondamatteo F, et al. Defining the Limits and the Spread Beyond the Transversus Abdominis Plane Block - Radiological and Anatomical Study. Reg Anesth Pain Med. 2008; 33(Sup 1): e7.
  24. Dam M, Moriggl B, Hansen CK, et al. The Pathway of Injectate Spread With the Transmuscular Quadratus Lumborum Block: A Cadaver Study. Anesth Analg. 2017; 125(1): 303–312.
  25. McDonnell JG, Curley G, Carney J, et al. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg. 2008; 106(1): 186–91, table of contents.
  26. Eslamian L, Jalili Z, Jamal A, et al. Transversus abdominis plane block reduces postoperative pain intensity and analgesic consumption in elective cesarean delivery under general anesthesia. J Anesth. 2012; 26(3): 334–338.
  27. Angle PJ, Halpern SH, Leighton BL, et al. A randomized controlled trial examining the effect of naproxen on analgesia during the second day after cesarean delivery. Anesth Analg. 2002; 95(3): 741–5, table of contents.
  28. Mishriky BM, George RB, Habib AS. Transversus abdominis plane block for analgesia after Cesarean delivery: a systematic review and meta-analysis. Can J Anaesth. 2012; 59(8): 766–778.
  29. Hartrick CT, Kovan JP, Shapiro S. The numeric rating scale for clinical pain measurement: a ratio measure? Pain Pract. 2003; 3(4): 310–316.
  30. Noblet J, Plaat F. Raising the standard... to unachievable heights? Anaesthesia. 2010; 65(1): 88–89.
  31. Halpern S, Yee J, Oliver C, et al. Pain relief after cesarean section: A prospective Cohort study. Can J Anesth. 2007; 54(S1): 44214–44214.
  32. Costello JF, Moore AR, Wieczorek PM, et al. The transversus abdominis plane block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve analgesia after cesarean delivery. Reg Anesth Pain Med. 2009; 34(6): 586–589.
  33. Griffiths JD, Le NV, Grant S, et al. Symptomatic local anaesthetic toxicity and plasma ropivacaine concentrations after transversus abdominis plane block for Caesarean section. Br J Anaesth. 2013; 110(6): 996–1000.
  34. Tuyakov B, Braczkowska M, Mieszkowski M, et al. Training in regional anesthesia. Pol Ann Med. 2016; 23(1): 80–85.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl