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Doctoral Thesis | Anaesthesiology | India | Volume 13 Issue 1, January 2024 | Rating: 5.9 / 10
Comparative Efficacy of Transmuscular and Intramuscular Quadratus Lumborum Blocks in Postoperative Analgesia for Caesarean Sections: A Randomized Study
Rahul Jain [3] | Langpoklakpam Chaoba Singh | Vasantharajan V | Sophia Koyu | Mayanglambam Sushmita Devi | Abid K Dodamani
Abstract: Background: The increasing prevalence of Lower Segment Caesarean Section surgery highlights the need for effective postoperative pain management. Severe pain associated with this surgery often requires analgesics, impacting maternal consciousness and bonding. This study investigates the comparative efficacy of transmuscular and intramuscular quadratus lumborum blocks in postoperative analgesia for Caesarean sections. Employing a randomized control trial design, the research evaluates pain intensity, opioid consumption, and potential side effects in patients receiving these two types of blocks. The findings aim to enhance understanding of optimal pain management strategies in post-Caesarean patients, potentially impacting clinical practices in obstetric surgery. Methods: In a double-blinded randomized controlled trial (RCT), 100 patients scheduled for elective lower segment Caesarean section surgery under spinal anesthesia were selected. They were evenly distributed into two groups, with 50 patients in each group. Group I, referred to as the TQLB group, received a transmuscular injection, while Group 2, known as the IQLB group, received an intramuscular injection of 0.375% Ropivacaine (20 ml) bilaterally. Results: In the Intramuscular Quadratus Lumborum Block (IQLB) group, the time for the first rescue analgesia ranged from 480-960 minutes, with a mean (? SE) of 716.60 ? 16.97 minutes and a median of 720 minutes. Meanwhile, in the Transmuscular Quadratus Lumborum Block (TQLB) group, it ranged from 720-1200 minutes, with a mean (? SE) of 964.80 ? 16.07 minutes and a median of 960 minutes. The mean time for the first rescue analgesia was comparatively higher in the TQLB group. Regarding rescue analgesia, in the IQLB group, 12 (24.0%) patients received 200 mg over 24 hours, whereas in the TQLB group, only 5 (10.0%) received the same dosage. Throughout all periods, the mean Visual Analog Scale (VAS) score was lower in the TQLB group compared to the IQLB group, except at 960 minutes, which may be attributed to the earlier requirement of rescue analgesia in the IQLB group. Conclusion: The transmuscular Quadratus Lumborum block demonstrated a longer duration of analgesia, reduced Visual Analog Scale (VAS) scores, and lower requirements for rescue analgesics compared to the intramuscular Quadratus Lumborum block. However, the intramuscular Quadratus Lumborum block was noted for better ease of performance. Importantly, there were no differences between the two groups concerning adverse reactions, indicating both methods were comparable in terms of safety.
Keywords: quadratus lumborum block, visual analogue scale, rescue analgesia, adverse reactions, lower segment caesarean section, Postoperative Analgesia, Transmuscular Approach, Intramuscular Approach
Edition: Volume 13 Issue 1, January 2024,
Pages: 961 - 970