Quadratus Lumborum Nerve Block Versus Transversus Abdominis Nerve Block in Pain Control After Caesarean Section; Randomized Controlled Trial

Abstract

esarean section rate increased those days and postoperative pain control. The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using multimodal analgesic therapy, preference for regional techniques, avoidance of sedatives, non-invasive ventilation with supplemental oxygen and early mobilization. In the past few years, transversus abdominis plane (TAP) block has been increasedly used for postoperative pain relief after cesarean section surgery. The main advantage of quadratus lumborum block (QLB) compared to TAP block is the extension of local anesthetic agent beyond the transversus abdominis plane to the thoracic paravertebral space. The wider spread of the local anesthetic agents may produce extensive analgesia and prolonged action of the injected local anesthetic solution. The aim of this study was to assess the analgesic efficacy of ultrasound-guided trans-muscular QLB compared with TAP block during cesarean section surgery and in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions. After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, female patients were included in the study, and were divided into two groups (n=25; each); group QLB and group TAP. • Group QLB: Patients (n=25) of this group received bilateral ultrasound-guided QLB after induction of regional anesthesia using 0.25% bupivacaine (25ml) with normal saline (1ml). • Group TAP: Patients (n=25) of this group received bilateral ultrasound-guided TAP block after induction of regional anesthesia using 0.25% bupivacaine (25ml) with normal saline (1ml). The two groups were adequately monitored and assessed post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first call for rescue analgesia. Demographic data, post-operative hemodynamics, and sedation score were also assessed. This prospective study was conducted at tertiary care hospital at Ain Shams University hospitals for one year from June 2020 to June 2021 and performed on total 50 patients who underwent elective cesarean section.