Quadratus lumborum or transversus abdominis plane block for postoperative analgesia after cesarean: a double-blinded randomized trial
Bloqueio do plano do quadrado lombar ou transverso do abdome para analgesia pós-operatória após cesariana: um estudo randomizado duplo-cego
Ashok Jadon, Mohammad Amir, Neelam Sinha, Swastika Chakraborty, Asif Ahmad, Sudeshna Mukherjee
Abstract
Background
Multimodal analgesia (MMA) is the current standard practice to provide post-cesarean analgesia. The aim of this study was to compare the analgesic efficacy of quadratus lumborum (QL) block and transversus abdominis plane (TAP) block as an adjunct to MMA.
Methods
Eighty mothers undergoing cesarean delivery under spinal anesthesia were randomized to receive either TAP or transmuscular QL block (QLB) with 20 mL 0.375% ropivacaine on each side. Postoperatively, all the subjects were assessed at 2, 4, 6, 8, 12, 18, and 24 hours. The primary outcome was the time to first analgesic request. The secondary outcomes were the pain scores during rest and movement, number of doses of tramadol, postoperative nausea-vomiting, sedation, and mother’s satisfaction with the pain management.
Results
The median (IQR) time to first analgesic request was 12 (9.25, 13) hours in the QL group and 9 (8.25, 11.37) hours in the TAP group (p = 0.0008). Patients in QL group consumed less doses of tramadol than TAP group (p < 0.0001). Pain scores were significantly lower in the QL group at all time points (p < 0.0001) except at 8th h where at rest, p = 0.0024, and on movement, p = 0.0028. The maternal satisfaction was significantly higher in the QL group (p = 0.0017).
Conclusion
Our study showed the significant delay in time to first analgesic request in QL group patients. Patients in the QL group had lower pain scores, required fewer analgesic supplements, and had more satisfaction. Nausea-vomiting and sedation were comparable.
Keywords
Resumo
Introdução: A analgesia multimodal (AMM) é a prática padrão atual para fornecer analgesia pós-cesariana. O objetivo deste estudo foi comparar a eficácia analgésica do bloqueio do quadrado lombar (QL) e do bloqueio do plano transverso abdominal (PTA) como adjuvante à AMM. Métodos: Oitenta mães submetidas a cesariana sob raquianestesia foram randomizadas para receber PTA ou bloqueio QL transmuscular (QL) com 20 mL de ropivacaína 0,375% de cada lado. No pós-operatório, todos os indivíduos foram avaliados em 2, 4, 6, 8, 12, 18 e 24 horas. O desfecho primário foi o tempo até a primeira solicitação de analgésico. Os desfechos secundários foram os escores de dor em repouso e movimento, número de doses de tramadol, náuseas-vômitos pós-operatórios, sedação e satisfação da mãe com o manejo da dor. Resultados: O tempo mediano (IQR) para a primeira solicitação de analgésico foi de 12 (9,25, 13) horas no grupo QL e 9 (8,25, 11,37) horas no grupo TAP (p = 0,0008). Os pacientes do grupo QL consumiram menos doses de tramadol do que o grupo TAP (p < 0,0001). Os escores de dor foram significativamente menores no grupo QL em todos os momentos (p < 0,0001), exceto na 8ª h onde em repouso, p = 0,0024, e em movimento, p = 0,0028. A satisfação materna foi significativamente maior no grupo QV (p = 0,0017). Conclusão: Nosso estudo mostrou o atraso significativo no tempo para a primeira solicitação de analgésico em pacientes do grupo QL. Os pacientes do grupo QL apresentaram escores de dor mais baixos, necessitaram de menos suplementos analgésicos e tiveram mais satisfação. Náusea-vômito e sedação foram comparáveis.
Palavras-chave
References
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