The analgesic effect of transmuscular quadratus lumborum block versus erector spinae plane block for women undergoing elective Caesarean section: A randomized controlled trial.

IF 1.3 Q4 CLINICAL NEUROLOGY British Journal of Pain Pub Date : 2023-10-01 Epub Date: 2023-06-02 DOI:10.1177/20494637231181513
Maha Mostafa, Mohamed A Nasr, Maher Fawzy, Aya E Awad, Mohsen M Waheeb
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Abstract

Background: We aimed to compare the analgesic effect and quality of recovery of transmuscular quadratus lumborum block (QLB) and erector spinae plane block (ESPB) in the presence of multimodal analgesia following Caesarean section.

Methods: This randomised controlled trial included full-term pregnant women who underwent elective Caesarean section under spinal anaesthesia without intrathecal morphine. The included women were randomised to receive either bilateral QLB (n = 51) or bilateral thoracic ESPB (n = 51), in addition to the control group (n = 51) who did not receive any block. All participants received regular paracetamol (1 g/6h) and diclofenac (50 mg/8 h). Intravenous morphine was used as a rescue analgesic. The primary outcome was time to first morphine requirement. Secondary outcomes included total postoperative morphine consumption and total Obstetric Quality of Recovery-11 (ObsQoR-11) score.

Results: We analysed 51, 50 and 48 patients in the QLB, ESPB and control groups, respectively. The time to first morphine requirement in both QLB and ESPB groups was longer than that in the control group (median [quartiles] time: 6 [6,12] h, 6 [6,6] h and 4 [3,4] h, respectively; p-value <0.001), without significant differences between the two former groups. The total morphine consumption in both QLB and ESPB groups was lower than that in the control group (median [quartiles]:0 [0,5] mg, 0 [0,5] mg and 25 [25,30] mg, respectively; p-value <0.001), without significant differences between the two former groups. The QLB and ESPB groups had comparable ObsQoR-11 score, and both groups' scores were higher than the control group.

Conclusion: In patients undergoing elective Caesarean section under spinal anaesthesia without intrathecal morphine, both QLB and ESPB provided superior analgesia and quality of recovery compared to the standard care, without significant difference between the two blocks.

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经腰方肌阻滞与竖脊肌平面阻滞对择期剖宫产妇女的镇痛效果:一项随机对照试验
背景:我们旨在比较在剖腹产后多模式镇痛的情况下,经血管腰方肌阻滞(QLB)和竖脊肌平面阻滞(ESPB)的镇痛效果和恢复质量。方法这项随机对照试验包括在脊髓麻醉下,在不鞘内注射吗啡的情况下进行选择性剖腹产的足月孕妇。除了未接受任何阻滞的对照组(n=51)外,纳入的女性被随机分配接受双侧QLB(n=51个)或双侧胸部ESPB(n=52个)。所有参与者定期服用扑热息痛(1g/6h)和双氯芬酸(50mg/8h)。静脉注射吗啡被用作抢救性镇痛药。主要结果是第一次需要吗啡的时间。次要结果包括术后吗啡总消耗量和产科总恢复质量-11(ObsQoR-11)评分。结果我们分别分析了QLB组、ESPB组和对照组的51例、50例和48例患者。QLB和ESPB组的首次吗啡需求时间均长于对照组(中位[四分位数]时间:分别为6[6,12]h、6[6,6]h和4[3,4]h;p值<0.001),前两组之间无显著差异。QLB组和ESPB组的吗啡总消耗量均低于对照组(中位[四分位数]:分别为0[0.5]mg、0[0.5]mg和25[25,30]mg;p值<0.001),前两组之间无显著差异。QLB和ESPB组的ObsQoR-11评分相当,两组的评分均高于对照组。结论在没有鞘内吗啡的脊髓麻醉下进行选择性剖腹产的患者中,与标准护理相比,QLB和ESPB都提供了更好的镇痛和恢复质量,两种阻滞之间没有显著差异。
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来源期刊
British Journal of Pain
British Journal of Pain CLINICAL NEUROLOGY-
CiteScore
3.20
自引率
11.10%
发文量
42
期刊介绍: British Journal of Pain is a peer-reviewed quarterly British journal with an international multidisciplinary Editorial Board. The journal publishes original research and reviews on all major aspects of pain and pain management. Reviews reflect the body of evidence of the topic and are suitable for a multidisciplinary readership. Where empirical evidence is lacking, the reviews reflect the generally held opinions of experts in the field. The Journal has broadened its scope and has become a forum for publishing primary research together with brief reports related to pain and pain interventions. Submissions from all over the world have been published and are welcome. Official journal of the British Pain Society.
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