Study shows quadratus lumborium block superior to TAP block
ESRA Academy. Van de Velde M. Mar 7, 2017; 170353
Dr. Marc Van de Velde
Dr. Marc Van de Velde
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Postoperative analgesia after Caesarean section is often problematic. Pain scores both at rest and on mobilisation are often reported to be high. Fear of medication (in terms of the neonate through breast feeding) by both the health care worker and the patient and the false idea this is a ‘minor’ procedure induce this problem of undertreated pain. Any attempt to improve pain relief is therefore welcome especially if one can achieve opioid sparing.
In this study Blanco et al compared two forms of abdominal wall blocks: the quadratus lumborum block and the transversus abdominis plane block. There results are convincing: a quadratus lumborum block reduces opioid consumption for up to 48 hours after surgery. So based on these results a quadratus lumborum block is certainly the way forward. However, practical issues might delay widespread introduction: contrary to a transversus abdominis plane block, to achieve a quadratus lumborum block, it is necessary to reposition the patient in the lateral position. This is not the case with a transversus abdominis plane block and, therefore, it will induce significant time loss. Clearly, abdominal wall blocks (transversus abdominis plane anterior, transversus abdominis plane posterior, ultrasound-guided transversus abdominis plane, quadratus lumborum block) have a benefit in the setting of a Caesarean section; however, more study is required to determine the most optimal option.


Effective postoperative analgesia after cesarean delivery enhances early recovery, ambulation, and breastfeeding. In a previous study, we established the effectiveness of the quadratus lumborum block in providing pain relief after cesarean delivery compared with patient-controlled analgesia (morphine). In the current study, we hypothesized that this method would be equal to or better than the transversus abdominis plane block with regard to pain relief and its duration of action after cesarean delivery.


Between April 2015 and August 2015, we randomized 76 patients scheduled for elective cesarean delivery under spinal anesthesia to receive the quadratus lumborum block or the transversus abdominis plane block for postoperative pain relief. This trial was registered prospectively (NCT 024489851).


Patients in the quadratus lumborum block group used significantly less morphine than the transversus abdominis plane block group (P < 0.05) at 12, 24, and 48 hours but not at 4 and 6 hours after cesarean delivery. This group also had significantly fewer morphine demands than the control group (P < 0.05) at 6, 12, 24, and 48 hours after cesarean delivery. No significant differences in visual analog scale results were shown between the 2 groups at rest or with movement. Calculated total pain relief at rest and with movement were similar (P < 0.001) in both groups.


The quadratus lumborum block was more effective in reducing morphine consumption and demands than transversus abdominis plane blocks after cesarean section. This effect was observed up to 48 hours postoperatively.

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