Quadratus Lumborum and Transversus Abdominis Plane Blocks and Their Impact on Acute and Chronic Pain in Patients after Cesarean Section: A Randomized Controlled Study.

Michał Borys,Piotr Węgrzyn,Ewa Gęszka,Aleksandra Zamaro,Marek Janiak,Beata Horeczy,Paweł Piwowarczyk,Mirosław Czuczwar

doi:10.3390/ijerph18073500

Abstract

Background: Severe postoperative pain is a significant problem after cesarean sections. Methods: This study was a randomized, controlled trial of 105 patients conducted in two hospitals. All patients were anesthetized spinally for elective cesarean section. Each participant was randomly allocated to one of three study groups: the quadratus lumborum block (QLB) group, the transversus abdominis plane block (TAPB) group, or the control (CON) group. The primary outcome of this study determined acute pain intensity on the visual analog scale (VAS). The secondary outcomes determined morphine consumption and chronic pain evaluation according to the Neuropathic Pain Symptom Inventory (NPSI) after hospital discharge. Results: At rest, the pain intensity was significantly higher in the CON group than in the QLB and TAPB groups at hours two and eight. Upon activity, the pain in the control subjects was more severe than in the QLB and TAPB groups in three and two of five measurements, respectively. Moreover, morphine consumption was significantly lower in the QLB (9 (5–10)) and TAPB (10 (6–14)) groups than in the CON (16 (11–19)) group. Persistent postoperative pain was significantly lower in the QLB group than in the CON group at months one and six following hospital discharge. Conclusions: Both the QLB and TAPB can improve pain management after cesarean delivery. Moreover, the QLB might reduce the severity of persistent postoperative pain months after cesarean section.

Highlights

Cesarean section is among the most common surgical procedures globally, and its use is on the rise in developed countries [1]
Spinal anesthesia provides excellent postoperative analgesia after cesarean section, its effect endures for only a few hours after the surgery, after which patients can suffer from severe postoperative pain [3]
Neuropathic Pain Symptom Inventory (NPSI)(Table was significantly lower at monthswas onenoted and in persistent pain severity between the we did find six in the quadratus lumborum block (QLB) group than in the CON group (Table 4)

Summary

Introduction

Cesarean section is among the most common surgical procedures globally, and its use is on the rise in developed countries [1]. Most scheduled cesarean deliveries are performed under anesthesia using spinal or epidural techniques [2]. Spinal anesthesia provides excellent postoperative analgesia after cesarean section, its effect endures for only a few hours after the surgery, after which patients can suffer from severe postoperative pain [3]. Alternative pain management strategies should be implemented. One reason for this is an association between postoperative pain in patients after cesarean delivery and the risk of postpartum depression. Mothers with severe postoperative pain have a higher chance of postpartum depression, which can negatively affect a child’s development [4,5]

Methods

Results

Conclusion