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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.d.18.00269    [Epub ahead of print]
Published online March 8, 2019.
Ultrasound guided bilateral quadratus lumborum block vs. intrathecal morphine for postoperative analgesia after cesarean section: a randomised controlled trial
Eman Ramadan Salama
Department of Anesthesia &Surgical ICU, Faculty of Medicine, Tanta University
Corresponding author:  Eman Ramadan Salama, Tel: +201277886405, Fax: +20402231671, 
Email: dr.ers1975@yahoo.com
Received: 10 September 2018   • Revised: 6 March 2019   • Accepted: 6 March 2019
Abstract
Background
Adequate pain control after cesarean section (CS) is important to help the newly delivered mothers to feed and care their neoborns together with early ambulation of the parturients to avoid the risk of thromboembolism and development of chronic abdominal and pelvic pain. The aim of this randomized controlled trial was to study and compare the efficacy of quadratus lumborum (QL) block and intrathecal morphine for postoperative analgesia after CS.
Methods
Ninety pregnant female patients with a gestation of 37 weeks or more scheduled for elective CS were enrolled into the study. All patients received spinal anesthesia, and after surgery, QL block was performed. They were randomly allocated to control group (CG, 0.1ml saline added to spinal drug and 24ml saline for QL block), intrathecal morphine group (ITM, 0.1mg morphine added to spinal drug and 24ml saline for QL block), or QL block group (QLB, 0.1ml saline added to spinal drug and 24ml 0.375% ropivacaine for QL block). Integrated Analgesia Score (IAS), Numerical rating scale (NRS) at rest and during movement, morphine requirements in the first 48-h, time to first morphine dose, time to first ambulation, and morphine related side effects were recorded.
Results
IAS and NRS scores at rest and during movements were significantly less in QLB and ITM than CG. Moreover, QLB had lower IAS and NRS scores at rest and during movements in comparison to ITM. Time to first morphine dose was significantly longer in QLB than in ITM and CG. Also, morphine requirements in the first 48-h was significantly lower in QLB than ITM and CG (18.2±9.6 mg in QLB vs and 42.8±10.4 mg and 61±12.9 mg in ITM and CG respectively) (P=0.001). No significant difference between the three groups regarding time to first ambulation (13.4±1.8 h in QLB vs 11.7±1.9 h in CG and 12.9±1.6 h in ITM). Incidence of morphine related side effects was significantly higher in ITM compared to CG and QLB.
Conclusion
Quadratus lumborum block and intrathecal morphine are effective analgesic regimens after cesarean section. However, quadratus lumborum block provides better long lasting analgesia together with reduction of total postoperative morphine consumption.
Key Words: Quadratus Lumborum, Spinal, Morphine, Analgesia, Cesarean Section


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