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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
  1. Christian K Hansen1,
  2. Mette Dam1,
  3. Gudny E Steingrimsdottir1,
  4. Gunnar Hellmund Laier2,
  5. Morten Lebech3,
  6. Troels Dirch Poulsen1,
  7. Vincent W S Chan4,
  8. Morné Wolmarans5,
  9. Thomas Fichtner Bendtsen6 and
  10. Jens Børglum1
  1. 1 Department of Anesthesiology, Zealand University Hospital, Roskilde, Denmark
  2. 2 Region Zealand, Sorø, Denmark
  3. 3 Department of Gynecology and Obstetrics, Zealand University Hospital, Roskilde, Denmark
  4. 4 Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
  5. 5 Anaesthesiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
  6. 6 Anesthesiology, Aarhus Universitetshospital, Aarhus, Denmark
  1. Correspondence to Dr Jens Børglum, Department of Anesthesiology, Zealand University Hospital, University of Copenhagen, DK-4000 Roskilde, Denmark; jens.borglum{at}gmail.com

Abstract

Background 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.

Methods A randomized double-blind trial with concealed allocation was conducted in 72 parturients who received bilateral TQL block with either 30 mL ropivacaine 0.375% or saline. TQL block injectate was deposited in the interfascial plane between the quadratus lumborum and psoas major muscles, posterior to the transversalis fascia. Primary outcome was opioid consumption, which was recorded electronically. Pain scores and time to first opioid request were also evaluated.

Results Opioid consumption (oral morphine equivalents, OME) was significantly reduced in group ropivacaine (GRO) in the first 24 hours compared with group saline (65 mg OME vs 94 mg OME) with a mean difference of 29 mg OME; 95% CI 3 to 55, p<0.03. Time to first opioid request was significantly prolonged in GRO, p<0.003. Numerical rating scale pain scores were significantly lower in GRO in the first 6 hours after surgery, p<0.03.

Conclusions 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.

  • truncal blocks
  • postoperative pain
  • obstetrics
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Footnotes

  • Contributors CKH, JB: planning, conducting, reporting, conception, design, acquisition of data, data analysis, interpretation of data and writing of the manuscript. MD: conducting, acquisition of data and writing of the manuscript. GES, ML, TRD: conception, design and writing of the manuscript. GHL: data analysis, interpretation of data and writing of the manuscript. VWSC, MW: interpretation of data and writing of the manuscript. TFB: planning, conception, design, interpretation of data and writing of the manuscript.

  • Funding This work was supported by the Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, University of Copenhagen, Denmark, and by the Research Foundation of Region Zealand.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the regional ethics committee of Region Zealand, Denmark (2017/SJ-594). The study was approved by the Danish Medicines Agency (EudraCT 2016-004594-41) and the Danish Data Protection Agency (REG-004-2017).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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