Quadratus Lumborum Block Type II Versus Transversus Abdominis Plane Block For Postcesarean Analgesia: A Randomized Double Blinded Trial.

Abstract

Multimodal analgesia including neuraxial opioids, systemic opioids, nonsteroidal anti-inflammatory drugs, local wound infiltration and regional blocks are preferred after cesarean section to reduce opioid consumption and to provide synergistic or additive analgesia. There have been studies comparing analgesic efficacy of quadratus lumborum block (QLB) type II over transversus abdominis plane (TAP) after cesarean delivery, which however fail to provide consistent results in terms of significant difference in post operative analgesia while comparing both blocks. Aims: To identify a superior analgesic technique for post cesarean analgesia by comparing QLB type 2 with TAP block as part of multimodal analgesia. Methods: Eighty parturients scheduled for elective caesarean section under spinal anaesthesia during 2022 to 2023 in a tertiary care hospital in Ernakulam were randomized to receive QLB type 2 (group1) and TAP block (group 2). The primary outcome was to compare cumulative tramadol consumption at predetermined time intervals. Secondary outcomes included the quality of postoperative analgesia using pain rating scale, duration of postoperative analgesia, cumulative supplemental analgesic consumption, sensory dermatomal involvement, comparison of side effects. Results: The study showed statistically significant differences between the two groups with respect to cumulative tramadol consumption 12 h and 24 h; Numerical Pain Rating scores (NRS) at 12 h and 24 h; the duration of post operative analgesia; cumulative supplemental analgesic dose consumption up to 24 h; sensory dermatomal spread six hours and 12 h and sedation scores and nausea.Conclusions: QLB type II reduced opioid and other analgesic requirements and provided with longer lasting analgesia, as compared to TAP Block after cesarean section.