Ultrasound guided quadratus lumborum and transversus abdominis plane block for postoperative analgesia in patients undergoing caesarean section under subarachnoid block: A comparative study

Sakera  Sultana; Sajib Kabir  Bhuiyan; Md Mosharaf  Hossain; Md. Bablu  Hossain; Md Mostafa  Kamal; Dilip Kumar  Bhowmick; A K M  Akhtaruzzaman

doi:10.62848/bjpain.v3i1.8711

Authors

Sakera Sultana Assistant Surgeon, Nilokhi Union Sub Centre, Homna, Cumilla
Sajib Kabir Bhuiyan Resident, Department of Neurosurgery, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
Md Mosharaf Hossain Anaesthesiologist, National Institute of Cancer Research and Hospital, Dhaka- 1212
Md. Bablu Hossain Anaesthesiologist, Rangpur Medical College Hospital, Rangpur, Bangladesh
Md Mostafa Kamal Anaesthesiologist, Shaheed Suhrawardy Medical College Hospital, Dhaka https://orcid.org/0000-0002-4665-1904
Dilip Kumar Bhowmick Assoc. Professor, Dept. of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU, Dhaka
A K M Akhtaruzzaman Professor, Department of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU, Dhaka, Bangladesh

DOI:

https://doi.org/10.62848/bjpain.v3i1.8711

Keywords:

Quadratus Lumborum block, transversus abdominis plane block, sub arachnoid block, caesarean section, local anaesthetic, postoperative analgesia

Abstract

Background: Effective postoperative pain management after caesarean section is very vital; because it helps early ambulation, facilitates breastfeeding and creates early mother-baby bonding. To reduce this significant postoperative pain various modalities are in current use. All truncal blocks can reduce postoperative pain and reduce opioid consumption after caesarean section significantly. This study aims to compare the effectiveness of USG guided Quadratus lumborum block and Transversus abdominis plane block in postoperative pain management in patients undergoing caesarean section.
Methods: This randomized controlled trial study was conducted in 60 patients, who were underwent elective caesarean section under sub arachnoid block in obstetric operation theatre, Bangabandhu Sheikh Mujib Medical University. The study populations were divided equally into two groups having same numbers of parturient in each. QL block group parturient received ultrasound guided quadratus lumborum block (0.20% bupivacaine) and TAP block group received transversus abdominis plane block (0.20% bupivacaine) after caesarean section. Total volume of the drugs (0.20% bupivacaine) is 20 ml on each side. Then collected data was recorded and compared between two groups: duration of analgesia, time of first analgesic requirement, total dose of opioid consumption in first 24 hours, postoperative pain by VAS score, sedation scale by Ramsay scale and satisfaction level by Likert scale between the groups.
Results: Socio-demographic profile were similar among the both groups (p>0.05). The mean VAS score was significantly low in QL block group as compared to the TAP block at 10th, 16th and 20th hours interval (p<0.05). Patients with QLB block had significantly late demand of 1st analgesic (14.35±2.55 vs 8.25±2.25) hours (p<0.05) and significantly less total opioid consumption (95.5±10.7 vs191.6±14.8) mg (p<0.05) compared to patients with TAP block. Post-operative complication was noted significantly higher among patients with TAP block compared to QL block. The level of satisfaction was much higher in QL block group then TAP
block group.
Conclusion: This study shows that quadratus lumborum block produce longer duration of analgesia which provides optimum post-operative pain control and reduce the opioid consumption among the patients than transversus abdominis plane block in case of caesarean section under subarachnoid block.