Quadratus lumborum block versus transversus abdominis plane block for post Caesarean analgesia: A randomized prospective controlled study

Abstract

BackgroundEffective postoperative analgesia after lower segment caesarean section (LSCS) is very important for early ambulation and early breast feeding and has a role to play in decreasing postpartum depression. Quadratus lumborum (QL) block, a fascial plane block, is gaining popularity for pain management in lower abdominal surgeries. The aim of the present study was to compare the ultrasound-guided (USG) transversus abdominis plane (TAP) block and QL block in patients undergoing LSCS under spinal anaesthesia. MethodsDouble-blinded, randomized, controlled, single-centre study done between Aug 2019 and Oct 2019, randomised 80 patients scheduled for LSCS into two groups, QL (N = 40) and TAP (N = 40), receiving USG TAP or QL block 20 ml of 0.25% bupivacaine with 4 mg dexamethasone bilaterally, postoperatively. ResultsSSPS 20 was used for the statistical analysis Patients were evaluated for 24-h using visual analogue scale (VAS) for pain scores, time to rescue analgesia and the analgesic dose requirement at regular time intervals. Fifteen percent patients in QL block and 75% in TAP block required rescue analgesia (P < 0.001). Significant differences were observed in pain scores at 10 h postoperatively, VAS in QL=1.18 (0.55), TAP=3.08 (1.66) (P < 0.001). By 24 h postoperatively the difference ceased to be statistically significant. Time to rescue analgesia in QL group was 1353 min (+/−224.07) and TAP group 915 min (+/−391.62) (P < 0.001). Average requirement of rescue analgesia (paracetamol) in QL group was 153.84 mg, TAP group 756.09 mg. ConclusionsPatients receiving QL block had prolonged analgesic effects and required less use of rescue analgesia in comparison with TAP group in the first 24 h postoperatively. Trial numberCTRI/2019/07/020475.