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The Effectiveness of Transversus Abdominis Plane and Quadratus Lumborum Blocks in Acute Postoperative Pain Following Cesarean Section-A Randomized, Single-Blind, Controlled Trial.

ABSTRACT: Acute pain intensity related to cesarean section (CS) may be extensive and is often underestimated. This may influence mothers' quality of life and their children's development. Regional analgesia techniques that include transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) have proven their efficacy in the postoperative period after CS. Although several randomized controlled studies and one meta-analysis have investigated the utility of TAPB and QLB in the reduction of acute and chronic pain after CS, only one study directly compared both types of regional blocks and revealed superiority of QLB over TAPB. Our study aimed to reevaluate the effectiveness of transversus TAPB and QLB in controlling acute postoperative pain after CS. We recruited 197 women with singleton pregnancies undergoing CS under spinal anesthesia. The patients were randomized to receive either TAPB or QLB after CS. The acute postoperative pain was evaluated using the visual analog scale (VAS) at 2, 4, 8, 12 and 24 h after the operation. No significant difference in acute postoperative pain intensity between the groups was found. The patients who received TAPB had a higher demand for supplemental morphine injections (p < 0.039). In our study, none of the evaluated regional blocks demonstrated an advantage over the other regarding acute postoperative pain management.

SUBMITTER: Borys M

PROVIDER: S-EPMC8296943 | biostudies-literature |

REPOSITORIES: biostudies-literature

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

Project description:Severe postoperative pain is a significant problem after cesarean sections. 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. 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. 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.

| S-EPMC8037180 | biostudies-literature

Effects of transversus abdominis plane block versus quadratus lumborum block on postoperative analgesia: a meta-analysis of randomized controlled trials.

Project description:BACKGROUND:Trunk block technique has been used in postoperative analgesia for patients undergoing surgery, specifically, transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) have been proved effective. The purpose of this meta-analysis is to evaluate the effects of TAPB and QLB in postoperative analgesia. METHODS:Online databases, including MEDLINE, EMBASE, Cochrane Library (&Trail), Web of Science, CNKI, Wanfang and QVIP were applied to collect the randomized controlled trials (RCTs) from inception to Dec. 9th, 2019. Twenty-two studies were finally included containing 777 patients in the TAPB group and 783 cases in QLB group. RCTs comparing TAPB and QLB in postoperative analgesia were included in this meta-analysis. The indicators including total analgesia consumption postoperatively, operative time, duration of anesthesia, visual analogue scale (VAS) score at 24?h postoperatively, duration of postoperative analgesia, the number of patients requiring analgesia postoperatively and adverse reactions were analyzed. RESULTS:our findings showed that morphine consumption (mg) (WMD?=?3.893, 95%CI: 2.053 to 5.733, P?<?0.001), fentanyl consumption (?g) (WMD?=?23.815, 95%CI: 15.521 to 32.109, P?<?0.001), VAS score at 24?h postoperatively (WMD?=?0.459, 95%CI: 0.118 to 0.801, P?=?0.008), the number of patients requiring analgesia postoperatively (WMD?=?3.893, 95%CI: 2.053 to 5.733, P?<?0.001), and the incidence of dizziness (WMD?=?2.691, 95%CI: 1.653 to 4.382, P?<?0.001) in TAPB group were higher than in QLB group. CONCLUSIONS:QLB is superior to TAPB in reducing morphine consumption, fentanyl consumption, VAS score at 24?h postoperatively, the number of patients requiring analgesia postoperatively, and the incidence of dizziness.

| S-EPMC7199334 | biostudies-literature

Lateral Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Laparoscopic Surgery: A Randomized Controlled Study.

Project description:BackgroundAfter laparoscopic abdominal surgery, we aim to evaluate the analgesic efficiency of US-directed bilateral transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB).Methods50 patients aged 18-60 years listed for elective laparoscopic abdomen operation were registered in this study. Cases were randomly allocated into two similar groups: TAPB and QLB groups. The first outcome was the growing morphine consumption on the 1st day postoperatively. The second outcome involved VAS score, first analgesic necessities, and any postoperative complications. Statistical analysis was done with the 2-sample t-test, and Mann-Whitney U testing was utilized to compare medians for skewed end points. Qualitative data were introduced as numbers and percentages, and chi-squared testing was utilized to determine the significance.ResultsThe median cumulative morphine consumptions on the 1st day were high significantly in the TAPB group than in the QLB group (6 mg [6, 9] vs. 3 mg [3, 6], p value ≤0.0001]). The QLB group showed an increase in the median of the time to the first analgesic request in comparison with the TAPB group (17 hours [12, 24] vs. 8 hours [6, 24], p ≤ 0.001). In addition, on the 1st day, the mean VAS scoring at rest was lower in the QLB group.ConclusionIn comparison to the TAPB, the QL block delivers more successful pain relief, has an extended period of analgesic actions, extends interval to the 1st analgesic necessity, is accompanied with lesser morphine consumptions, and may be utilized in multimodal analgesia and opioid-sparing regimens after that laparoscopic operation. This trial is registered with NCT04553991.

| S-EPMC8979728 | biostudies-literature

Transmuscular quadratus lumborum block versus oblique subcostal transversus abdominis plane block for analgesia in laparoscopic hysterectomy: a randomised single-blind trial.

Project description:ObjectiveThe transmuscular quadratus lumborum (TQL) block and the oblique subcostal transversus abdominis plane (OSTAP) block both contribute to multimodal analgesia after laparoscopic surgery. The objective of this study was to compare the analgesic effects of the TQL block versus OSTAP block after laparoscopic hysterectomy.DesignProspective single-centre randomised single-blind trial.SettingUniversity-affiliated hospital.ParticipantsPatients aged between 18 and 65 years scheduled for laparoscopic hysterectomy.InterventionsPatients were randomised into two groups (1:1 ratio) and received bilateral TQL block or bilateral OSTAP block with 0.375% ropivacaine 20 mL on each side before surgery.Primary and secondary outcome measuresThe primary outcome measure was the cumulative morphine dose in the first 24 hours. The secondary outcome measures were the morphine consumption at each time interval after surgery, the time from the end of surgery to the first need for morphine, the Numerical Rating Scale (NRS) scores for visceral and incisional pain intensity, and the incidence of adverse events.ResultsThe cumulative morphine dose was significantly lower in the TQL group than in the OSTAP group (17.2 (12.5) vs 26.1 (13.3) mg, p=0.010). Compared with the OSTAP group, the morphine doses from 6 to 12, 12 to 18, and 18 to 24 hours were significantly lower, the time of first need for morphine was significantly longer and the NRS scores for visceral pain intensity were significantly lower in the TQL group.ConclusionCompared with the OSTAP block, the TQL block reduced morphine consumption and provided better visceral pain relief with a longer duration of effect after laparoscopic hysterectomy.Trial registration numberChinese Clinical Trial Registry (ChiCTR1800017995); pre-results.

| S-EPMC8356166 | biostudies-literature

Posterior quadratus lumborum versus transversus abdominis plane block for inguinal hernia repair: a prospective randomized controlled study.

Project description:Background and objectivesWe aimed to compare the analgesic effects of both posterior (type 2) Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) compared to spinal anesthesia alone for postoperative pain management in inguinal hernia repair.MethodsThis study enrolled 63 patients scheduled for open inguinal hernia repair. The eligibility criteria were undergoing elective unilateral inguinal hernia repair surgery, having an American Society of Anesthesiologists (ASA) physical status I, II, or III, and not suffering from any chronic pain condition. Group S patients received spinal anesthetics and no additional analgesic treatments. Group T patients received TAPB, and Group Q patients received QLB as analgesic technique in addition to spinal anesthetics.ResultsThe pain scores at 6 hours (VAS 6) and 24 hours (VAS 24) were significantly different between groups (p < 0.01). Additionally, the sensory and motor block levels were significantly different between groups (p < 0.05). Multiple comparison tests showed that patients in Group Q had significantly higher sensory and motor block levels (p < 0.01 compared with Group S; p < 0.05 compared with Group T). Opioid consumption was significantly different between Groups Q and S (p < 0.01) after surgery.ConclusionsOur findings show that both blocks are similarly effective for the management of postoperative pain compared to spinal anesthesia alone for inguinal hernia repair. We found that QLB resulted in a significant cranial spread compared to TAPB. Opioid consumption in QLB was significantly lower than that in controls but similar to that in TAPB.

| S-EPMC9373607 | biostudies-literature

Quadratus Lumborum Block Against Coupled Transversus Abdominis Block and Ilioinguinal/Iliohypogastric Nerve Blocks for Postoperative Analgesia After Total Abdominal Hysterectomy: A Randomized Controlled Trial.

Project description:BackgroundNerve blocks have been one of the most common anesthetic methods for abdominal surgeries since the last four decades.ObjectivesThis study aimed to compare the postoperative analgesic efficacy of bilateral ultrasound-guided quadratus lumborum block (QLB) against bilateral ultrasound-guided transversus abdominis block (TAB) and Ilioinguinal/Iliohypogastric nerve blocks (IINB) in abdominal total hysterectomy.MethodsSixty female patients scheduled for the surgery of total abdominal hysterectomy under spinal anesthesia participated in this randomized prospective trial. They were randomly assigned to two dual TAB / IINB (n = 30) and QLB (n = 30) groups. Moreover, the visual analog scores (VAS), the total amount of morphine consumed after surgery during the first 24 hours, the number of individuals requiring rescue analgesia, postoperative analgesia duration, and postoperative complications were recorded.ResultsMorphine consumption was equal in both groups (P = 0.908). Furthermore, the analgesia duration in the two groups was statistically insignificant (P = 0.879), with mean values of 15.4 and 15.6 hours, respectively. During 24 hours, there was no statistically significant difference in terms of VAS between the two groups (P > 0.05).ConclusionsThe QLB might be a viable replacement for TAB/IINB for postoperative analgesia after total abdominal hysterectomy.

| S-EPMC10439688 | biostudies-literature

Comparison of ultrasound-guided quadratus lumborum block-2 and quadratus lumborum block-3 for postoperative pain in cesarean section: A randomized clinical trial.

Project description:IntroductionThe aim of this study was to compare the postoperative analgesic effects of ultrasound-guided quadratus lumborum block-2 (QLB-2) and quadratus lumborum block-3 (QLB-3) after cesarean section (C/S) under general anesthesia.MethodThis was a prospective, randomized, double-blind study. A total of 143 term pregnant women with American Society of Anesthesiologists II status, who were scheduled for elective C/S under general anesthesia were randomly separated into QLB-2 and QLB-3 groups. After surgery under standardized general anesthesia, QLBs were performed with 0.3 mL.Kg-1 0.25% bupivacaine in both groups. Patient-controlled analgesia (PCA) devices were used for additional analgesia. The primary outcomes were pain scores evaluated at 0, 2, 6, 12, and 24 hours. In addition, PCA demands, actual delivered tramadol doses, rescue analgesic requirements, anesthesia time, and patient satisfaction were recorded.ResultsA total of 104 patients were analyzed statistically. Pain scores were statistically lower in the QLB-3 group at 2, 6, 12, and 24 hours postoperatively (P = .001). Anesthesia time was longer in the QLB-3 group. Patients who received QLB-3 block demonstrated significantly fewer PCA demands and lower consumption of tramadol (P = .003). Moreover, the first analgesic requirement time was longer along with higher patient satisfaction. In addition, all procedures were performed without any complications and side effects due to PCA were negligible.ConclusionsThis study demonstrated that, although both QLBs were safe and reliable, QLB-3 provides more effective analgesia and patient satisfaction than QLB-2 in C/S.

| S-EPMC9750657 | biostudies-literature

The optimal concentration of ropivacaine for transversus abdominis plane blocks in elective cesarean section: A protocol for systematic review and meta-analysis.

Project description:IntroductionTransversus abdominis plane (TAP) blocks are commonly performed for postoperative analgesia in elective cesarean section. Ropivacaine is the most commonly used local anesthetic for TAP blocks. Currently, the concentration of ropivacaine for TAP blocks is various, and increasing number of randomized controlled trials (RCTs) have compared the effects of different concentration of ropivacaine for TAP blocks in cesarean section. This protocol of a systematic review and meta-analysis aims to identify the optimal concentration of ropivacaine for TAP blocks in elective cesarean section.Methods and analysisDatabases including PubMed, Web of science, the Cochrane library, and EMBASE will be searched from their inception to May 1, 2024. RCTs that investigated the analgesia of different concentrations of ropivacaine for TAP blocks in elective cesarean section will be identified. The analgesia duration will be the primary outcome. Secondary outcomes will include the analgesics consumption over postoperative 24 hours, postoperative pain scores at rest and movement, and the incidence of adverse effects. RevMan 5.4 software will used for statistical analysis. The evidence quality of synthesized results will be evaluated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.Ethics and disseminationEthical approval is not applicable. The results of this study will be published on completion.Trial registrationPROSPERO registration number: CRD42024496907.

| S-EPMC11309379 | biostudies-literature

Comparison of the postoperative analgesic effect of transversus abdominis plan block and quadratus lumborum block: A prospective randomized study.

Project description:Background and aimsIn this study, we aimed to compare the transversus abdominis plan block (TAP) and quadratus lumborum block (QL) efficacy for postoperative analgesia in patients undergoing varicocelectomy under spinal anesthesia.MethodsAmerican Society of Anesthesiologists (ASA) 1 and 2 patients, aged 18-45 years, who underwent varicocelectomy operation under elective conditions, were included. Eighty patients were divided into three groups as TAP group, QL group, and control group by prospective randomization. The patients were operated under spinal anesthesia. At the end of the operation, TAP was applied to the TAP group with a posterior approach using ultrasound (USG) in the supine position. To the QL group, the patient was placed in the lateral decubitus position and the lateral QL was applied via USG. No block type was applied to the control group. Patient-controlled analgesia (PCA) device containing tramadol was administered intravenously at the end of the surgery in all groups. Visual analogue scale (VAS) score was questioned at 0, 2, 4, 6, 8, 10, 12, 18, 24 h in the follow-up of the patients. Intravenous 1 g paracetamol was given over VAS 4. PCA usage time and usage amounts were recorded.ResultsAs a result of comparing the groups according to the VAS scores at all hours were significantly different between the three groups (p < 0.001). There was a significant difference between the groups when comparing the number of PCA bolus administrations (p < 0.001). TAP and QL blocks significantly reduced the number of PCA bolus when compared with the control group (p < 0.001) but the number of PCA bolus was found to be similar between TAP and QL blocks (p > 0.05).ConclusionTAP and QL, which are administered to evaluate the effectiveness of postoperative analgesia in patients undergoing varicocelectomy under spinal anesthesia, are both effective in reducing pain scores and the amount of analgesia consumption.

| S-EPMC9358534 | biostudies-literature

Comparison of Analgesic Effect Between Erector Spinae Plane Block and Transversus Abdominis Plane Block After Elective Cesarean Section: A Prospective Randomized Single-Blind Controlled Study.

Project description:BackgroundThis study compared the analgesic efficacy of a bilateral erector spinae plane (ESP) block with that of a bilateral transversus abdominis plane (TAP) block after elective cesarean delivery.MethodsSixty mothers scheduled for elective cesarean delivery under spinal anesthesia were randomly allocated to receive either ESP block or TAP block. The ESP group received ESP block at the level of the ninth thoracic transverse process with 20 mL of 0.25% bupivacaine at the end of surgery. The TAP group received an ultrasound-guided TAP block with 20 mL of 0.25% bupivacaine on completion of delivery. The primary outcome was the duration of analgesia achieved by each block. Secondary outcome measures were the postoperative pain severity, total tramadol consumption, patient satisfaction.ResultsThe median (interquartile range) duration of block was longer in the ESP group than in the TAP group (12 hours [10, 14] vs 8 hours [8, 8], p<0.0001). In the first 24 hours, the mean visual analog pain score at rest was lower by 0.32 units in the ESP group. The median tramadol consumption in the first 24 hours was significantly higher in the TAP group than in the ESP group (125 mg [100, 150] vs 100 mg [75, 100, p=0.003]).ConclusionCompared with the TAP block, the ESP block provides more effective pain relief, has a longer duration of analgesic action, prolongs time to first analgesic requirement, is associated with less tramadol consumption, and can be used in multimodal analgesia and opioid-sparing regimens after cesarean section.

| S-EPMC7245460 | biostudies-literature

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