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Created August 2, 2019, last updated almost 4 years ago.
Collection: 107, Score: 1658, Trend score: 0, Read count: 2191, Articles count: 8, Created: 2019-08-02 07:10:38 UTC. Updated: 2021-02-08 23:43:47 UTC.Notes
What is the Quadratus Lumborum Block (QLB)?
The quadratus lumborum muscle is the deepest abdominal wall muscle, running posteriorly, dorsolateral to psoas major. Three different types of QLB have been described
What's the deal with QLB for Cesarean section?
QLB is interesting because it may offer analgesia for visceral pain after caesarean section, in addition to somatic pain. Visceral pain may be a significant contributor to post-CS pain experience, and is not blocked by existing adjuvant techniques such as the transversus abdominal plane (TAP) block.
The proposed effect of QLB on visceral pain may be due to local anaesthetic spread to the paravertebral space, although evidence confirming this is scant and suggests it occurs only in small volumes and inconsistently at best.
Additionally, as with the demonstrated inadequacy of objective sensory block from a TAP block, studies of the sensory level effects of QLB also show limited actual sensory block – even if the QLB has shown some analgesic benefit in some studies.
Some QLB studies have shown analgesic benefit for post-CS patients, although most are small studies. At this stage it appears unlikely that QLB provides routine analgesic benefit for patents already receiving standard-of-care multimodal analgesia in combination with a neuraxial anaesthetic for caesarean ection.
Daniel Jolley
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Collected Articles
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Int J Obstet Anesth · Nov 2019
Randomized Controlled Trial Comparative StudyA triple-blinded randomized trial comparing spinal morphine with posterior quadratus lumborum block after cesarean section.
What did they do?
Tamura and team randomised 176 elective CS patients to spinal anaesthesia with or without morphine, in addition to placebo or ultrasound-guided quadratus lumborum block (QLB).
And they found
Only intrathecal morphine significantly improved analgesia, not QLB whether performed with or without spinal morphine. Thus QLB probably does not improve analgesia further beyond current best practices.
Not so fast...
While this modest-sized RCT concluded that QLB did not improve pain after caesarean section, the conclusion is i) somewhat inconsistent with earlier studies that did show benefit, and ii) the adjuvant analgesic regime1 used may not be applicable to practice outside Japan.
summary
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The researchers administered the remaining 90 mcg fentanyl IV, along with droperidol 1.25 mg and acetaminophen/paracetamol 15mg/kg after baby delivery. An NSAID (diclofenac 50mg) was only provided when breakthrough pain was requested. ↩
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Randomized Controlled Trial
Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial.
Quadratus lumborum block may improve analgesia and reduce morphine use after Caesarean section.
pearl -
Reg Anesth Pain Med · Jul 2019
Ultrasound-guided transmuscular quadratus lumborum block for elective cesarean section significantly reduces postoperative opioid consumption and prolongs time to first opioid request: a double-blind randomized trial.
Elective cesarean section (ECS) can cause moderate to severe pain that often requires opioid administration. To enhance maternal recovery, and promote mother and baby interaction, it is important to reduce postoperative pain and opioid consumption. Various regional anesthesia techniques have been implemented to improve postoperative pain management following ECS. This study aimed to investigate the efficacy of bilateral ultrasound-guided transmuscular quadratus lumborum (TQL) block on reducing postoperative opioid consumption following ECS. ⋯ Bilateral TQL block significantly reduced 24 hours' opioid consumption. Further, we observed significant prolongation in time to first opioid, and significant reduction of pain during the first 6 postoperative hours.
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Korean J Anesthesiol · Apr 2020
Randomized Controlled TrialUltrasound guided bilateral quadratus lumborum block vs. intrathecal morphine for postoperative analgesia after cesarean section: a randomised controlled trial.
Adequate pain control after cesarean section (CS) is crucial for mothers caring for newborns, and early ambulation to avoid thromboembolism and chronic abdominal and pelvic pain. This randomized controlled trial compared the efficacy of quadratus lumborum block (QLB) and intrathecal morphine (ITM) for analgesia after CS. ⋯ QLB and ITM are effective analgesic regimens after CS. However, QLB provides better long-lasting analgesia and reduced total postoperative morphine consumption.
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Anesthesia and analgesia · Feb 2018
The Analgesic Effect of Ultrasound-Guided Quadratus Lumborum Block After Cesarean Delivery: A Randomized Clinical Trial.
Landmark and ultrasound-guided transversus abdominis plane blocks have demonstrated an opioid-sparing effect postoperatively after cesarean delivery. The more posterior quadratus lumborum (QL) might provide superior local anesthetic spread to the thoracolumbar fascia and paravertebral space. The aim of our study was to evaluate the efficacy of the QL block after cesarean delivery. ⋯ QL block with ropivacaine reduces the postoperative ketobemidone consumption and pain intensity as a part of a multimodal analgesic regimen that excludes neuraxial morphine.
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Reg Anesth Pain Med · Nov 2016
Randomized Controlled TrialQuadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Pain After Cesarean Delivery: A Randomized Controlled Trial.
The quadratus lumborum block (QLB) may be more effective than transversus abdominos plane (TAP) block for cesarean section analgesia.
pearl -
Journal of anesthesia · Feb 2019
Randomized Controlled Trial Comparative StudyLocal anesthetic spread into the paravertebral space with two types of quadratus lumborum blocks: a crossover volunteer study.
Previous work showed that 20 mL of local anesthetic (LA) did not spread into the paravertebral space (PVS) via the intramuscular quadratus lumborum block (QLBi). If spread of LA into the PVS can be achieved by increasing the total LA volume, QLBi can be more effective. We hypothesized that a larger volume of LA for the QLBi would spread into the PVS. ⋯ LA administered by the QLB2 spreads into the PVS of T10-T12, resulting in lower and lateral abdominal sensory loss. In contrast, LA administered by the QLBi does not spread into the PVS and results in only lateral abdominal sensory loss.
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Randomized Controlled Trial
Transversus abdominis plane block does not improve early or late pain outcomes after Cesarean delivery: a randomized controlled trial.
Transversus abdominis plane block does not improve post-caesarean analgesia in women receiving regional anaesthesia with intrathecal morphine.
pearl
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