Quadratus Lumborum Block

Regional nerve blocks potentially offer superior pain control for patients undergoing primary total hip arthroplasty. However, the optimal single-shot regional anaesthesia modality remains unclear. PubMed, Embase, Cochrane, and Web of Science databases were searched from inception to May 5, 2024. Randomised controlled trials comparing various single-shot regional anaesthesia modalities were included. Frequentist and component network meta-analyses were performed. The primary outcomes included static and dynamic pain (visual analogue scale [VAS]) at 6 and 12 h after operation and total morphine consumption at 24 h. Additional outcomes included opioid-related adverse effects, patient satisfaction, quality of recovery, and postoperative lower limb muscle power. Eighty-seven randomised controlled trials were included. In static VAS, femoral nerve block ranked best (surface under the cumulative ranking curve (SUCRA)=92.8%), followed by lumbar plexus block (LPB) plus local infiltrative analgesia (LIA) (SUCRA=85.7%) at 6 h after operation. At 12 h after operation, LPB plus LIA was top ranked (SUCRA=89.2%), followed by quadratus lumborum block plus fascia iliaca compartment block (FICB) (SUCRA=84.8%). In dynamic VAS, pericapsular nerve group (PENG) block plus LIA (SUCRA=86.3%) and LPB plus LIA (SUCRA=83.4%) ranked best at 6 and 12 h after operation, respectively. In total morphine consumption at 24 h after operation, quadratus lumborum block plus FICB ranked highest (SUCRA=85.5%), followed by LPB plus LIA (SUCRA=82.2%) and PENG plus LIA (SUCRA=76.5%). LPB, FICB, and femoral nerve block were associated with increased motor blockade affecting quadriceps or adductor muscles based on qualitative analysis. Combined regional anaesthesia modalities, particularly PENG plus LIA, are favourable options for primary total hip arthroplasty procedures, as they result in lower pain scores, reduced opioid consumption, and motor-sparing effects in the early postoperative period. PROSPERO (CRD42024544358).

Caesarean section is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and patient satisfaction as well as breastfeeding success and mother-child bonding. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language between 1 May 2014 and 22 October 2020 evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane databases. Studies evaluating pain management for emergency or unplanned operative deliveries or caesarean section performed under general anaesthesia were excluded. A total of 145 studies met the inclusion criteria. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, recommendations include intrathecal morphine 50-100 µg or diamorphine 300 µg administered pre-operatively; paracetamol; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone administered after delivery. If intrathecal opioid was not administered, single-injection local anaesthetic wound infiltration; continuous wound local anaesthetic infusion; and/or fascial plane blocks such as transversus abdominis plane or quadratus lumborum blocks are recommended. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs with opioids used for rescue. The surgical technique should include a Joel-Cohen incision; non-closure of the peritoneum; and abdominal binders. Transcutaneous electrical nerve stimulation could be used as analgesic adjunct. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations. Some interventions were not recommended due to insufficient, inconsistent or lack of evidence. Of note, these recommendations may not be applicable to unplanned deliveries or caesarean section performed under general anaesthesia.

To compare the efficacy of quadratus lumborum block at lateral supra-arcuate ligament (QLB-LSAL) and erector spinae plane block (ESPB) for perioperative analgesia and early postoperative recovery outcomes in patients undergoing posterior lumbar interbody fusion (PLIF). We hypothesize that the QLB-LSAL technique combined with general anesthesia provides superior perioperative analgesic efficacy and enhanced postoperative recovery outcomes compared to the ESPB approach. This was a single-center, randomized controlled trial conducted using a patient- and assessor-blinded design, and this study comprised three groups: the Control group, the QLB-LSAL group, and the ESPB group. From May to August 2024, 96 patients undergoing posterior lumbar surgery were randomized to three groups. Following the induction of anesthesia, the QLB-LSAL and ESPB groups underwent bilateral ultrasound-guided blocks with 20 mL of 0.4% ropivacaine administered on each side, whereas the control group received general anesthesia alone without any injection procedures. The primary outcome was intraoperative remifentanil use. The secondary outcomes included: (1) intraoperative hemodynamics and vasopressor requirements; (2) anesthetic consumption; (3) C-reactive protein levels; (4) Visual Analog Scale; (5) number of patients requiring postoperative rescue analgesia; (6) Likert scale; (7) Br&#xf8;gger Comfort Scale scores; (8) Richmond Agitation and Sedation Scale scores; (9) Mini-Mental State Examination; (10) Self-Rating Anxiety Scale scores; (11) Pittsburgh Sleep Quality Index scores; (12) recovery milestones, including time to emergence, extubation, PACU discharge, first oral intake, first flatus, and ambulation; (13) 15-item Quality of Recovery scores; and (14) intraoperative adverse events. Thirty participants were included in each study group. (1) QLB-LSAL and ESPB demonstrated superior hemodynamic stability over controls (QLB-LSAL&#x2009;>&#x2009;ESPB). Remifentanil requirements were lower in QLB-LSAL and ESPB versus controls (all p&#x2009;<&#x2009;0.05). Postoperatively, QLB-LSAL and ESPB groups showed better pain score and comfort score (p&#x2009;<&#x2009;0.05), with QLB-LSAL requiring fewer rescue analgesics versus controls and outperforming ESPB in activity pain score at 12&#xa0;h (p&#x2009;<&#x2009;0.05). (2) QLB-LSAL exhibited superior neuropsychiatric recovery (Richmond Agitation-Sedation Scale, Mini-Mental State Examination, Self-Rating Anxiety Scale and Pittsburgh Sleep Quality Index) and shorter emergence, extubation, PACU stay, first ambulation time, and higher QoR-15 scores on postoperative days 1/3 versus controls (p&#x2009;<&#x2009;0.05). The ESPB group demonstrated fewer statistically significant advantages over controls in specific postoperative neuropsychiatric and physical rehabilitation metrics. Notably, QLB-LSAL reduced PACU duration by 11&#xa0;min versus ESPB (p&#x2009;<&#x2009;0.05). Both QLB-LSAL and ESPB reduced opioid consumption. Moreover, QLB-LSAL demonstrated superior analgesic efficacy. Both techniques facilitated recovery following lumbar spine surgery under general anesthesia, with QLB-LSAL associated with more rapid and effective recovery. Trial registration: Name of the registry the Chinese Clinical Trial Registry, Trial registration number ChiCTR2400084870, Date of registration 05/27/2024, URL of trial registry record https://www.chictr.org.cn/showproj.html?proj=229297 .

Cesarean delivery is one of the most common surgical procedures worldwide and is associated with moderate-to-severe postoperative pain. This review summarizes current evidence and guidelines for optimizing postoperative pain management while minimizing opioid-related side effects. Neuraxial long-acting opioids remain the gold standard but are limited by side effects such as pruritus, nausea, and urinary retention. Field blocks, including quadratus lumborum and erector spinae blocks, offer promising alternatives, though no single technique has demonstrated clear superiority over the other. Epidural analgesia provides effective pain control; however, its impact on early recovery limits its use in many settings. Routine administration of paracetamol and nonsteroidal anti-inflammatory drugs forms the foundation of multimodal analgesia and is universally recommended for being a simple intervention with minimal side effects. A single intraoperative dose of dexamethasone enhances analgesia and reduces opioid consumption without increasing risk of wound complications. Adjuvant analgesic techniques such as transcutaneous electrical nerve stimulation show potential benefits; however, more high-quality evidence is required before its implementation in routine practice. Finally, this review highlights gaps in current knowledge and emphasizes the need for standardized protocols and high-quality comparative studies to refine analgesic strategies for cesarean delivery.

No regional blockade techniques are considered standard of care for total laparoscopic hysterectomy (TLH). Quadratus lumborum block (QLB), a novel fascial plane block, has emerged as a potential option; however, its analgesic efficacy in TLH remains unclear. We conducted a comprehensive search across multiple databases, including Medline PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science. No filters or language restrictions were imposed. The Population, Intervention, Comparison, and Outcomes framework in this review was as follows: (1) adult patients undergoing TLH; (2) QLB as the intervention; (3) comparison with no block or placebo; (4) primary outcome: 24-hour postoperative intravenous morphine-equivalent consumption; secondary outcomes: postoperative pain at 2, 4, 6, 12, and 24 hours, and the incidence of postoperative nausea and vomiting (PONV); (5) randomized controlled trials. Meta-analyses, including subgroup and sensitivity analyses, were conducted using a random-effects model. This analysis included 8 trials with 540 patients. QLB significantly reduced postoperative 24-hour intravenous morphine-equivalent consumption following TLH (mean difference: -4.61 mg; 95% confidence interval: -7.13 to -2.09; p <.001; I&#xb2; = 57%), though the reduction was below the minimal clinically important difference (MCID) of 10 mg. The static pain scores at 2, 6, and 12 hours, as well as dynamic pain scores at 2, 6, and 24 hours postoperatively, were significantly lower in the QLB group than in the control group. However, only the 2-hour postoperative dynamic pain score (mean difference = 1.19) exceeded the MCID of 1. No statistically significant differences were observed in the incidence of PONV. QLB statistically reduced postoperative opioid consumption and pain scores at certain time points after TLH, but only the 2-hour dynamic pain score exceeded the MCID with no improvement in PONV, suggesting limited clinical benefit of QLB in TLH.

Background and Objectives: Although various regional anesthesia techniques are commonly used for laparoscopic cholecystectomy (LC), to date, no randomized controlled trial has compared the effectiveness of Quadratus Lumborum Plane Block (QLB) and External Oblique Intercostal Plane Block (EOIPB) in LC. Our aim was to compare the effectiveness of ultrasound-guided QLB and EOIPB in providing postoperative analgesia after LC. Materials and Methods: In this two-center, randomized controlled trial, patients undergoing LC were divided into QLB and EOIPB groups. Our primary outcome was the postoperative pain scores measured using the Numerical Rating Scale (NRS) at predetermined intervals. Secondary outcomes included opioid consumption, Riker Sedation-Agitation Scale (RSAS) score, and patient satisfaction. Results: The NRS pain scores at postoperative 30th minute, 4th, 12th, and 24th hours were significantly lower in the QLB group (p < 0.05). Patients in the QLB group required significantly less tramadol compared to the EOIPB group (p < 0.000). The QLB group also demonstrated lower RSAS scores (p = 0.005), indicating a smoother recovery process. Patient satisfaction scores were markedly higher in the QLB group (p < 0.000). Although both blocks were well-tolerated with no differences in side effects, EOIPB was associated with higher opioid consumption, indicating its relatively limited effectiveness. Conclusions: To conclude, this study highlights that QLB is a more effective option for postoperative analgesia and improves patient satisfaction after LC. EOIPB may serve as a viable alternative for some patients; however, given the advantages of QLB in pain control and recovery, it stands out as a more preferable method.