The aim of this study was to investigate the analgesic efficacy of Quadratus lumborum block (QLB) versus controls, transversus abdominis plane (TAP) block and neuraxial morphine, or when added to neuraxial morphine in women undergoing cesarean delivery.
Systematic review and meta-analysis with trial sequential analysis.
Parturients undergoing cesarean delivery.
Quadratus lumborum block for postoperative analgesia.
The primary outcomes were dynamic and static pain scores and cumulative opioid consumption at 24Â h. Secondary outcomes were dynamic and static pain scores and opioid consumption at 6 and 12Â h. Certainty of evidence was assessed using the GRADE system. Trial sequential analyses (TSA) were performed to determine if the results are supported by sufficient data.
Ten studies involving 761 parturients were included. Compared to controls, no difference in dynamic (MD -6; 95%CI -17 to 5) or static (MD -5; 95%CI -14 to 3) pain scores were noted with QLB at 24Â h (moderate certainty), although opioid consumption (MD -10.64Â mg morphine equivalents; -16.01 to -5.27) was reduced (high certainty), supported by sufficient data. QLB reduced dynamic pain at 6Â h, and static pain and opioid consumption at 6 and 12Â h compared to controls. Compared to neuraxial morphine, QLB did not alter opioid consumption or pain scores at 24Â h (low certainty), although TSA suggests insufficient data. Due to limited data, meta-analysis and TSA were not performed to compare QLB and TAP blocks. Addition of QLB to neuraxial morphine did not alter dynamic and static pain scores at 24Â h (moderate certainty, supported by sufficient data).
QLB improves post-cesarean delivery analgesia in parturients not receiving neuraxial morphine. Addition of QLB to parturients receiving neuraxial morphine has no significant analgesic benefit. Insufficient data are available to draw firm conclusions of QLB compared to TAP blocks or neuraxial morphine.
Copyright © 2020 Elsevier Inc. All rights reserved.
About The Expert
Hon Sen Tan
Cameron Taylor
Dan Weikel
Karen Barton
Ashraf S Habib
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