Comparative Study between Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Block in Post-Operative Pain Management after Cesarean Section

Abstract Background Cesarean section rate increased those days and postoperative pain control. The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using multimodal analgesic therapy, preference for regional techniques, avoidance of sedatives, non-invasive ventilation with supplemental oxygen and early mobilization. Aim of the Work The aim of this study was to assess the analgesic efficacy of ultrasound-guided trans- muscular QLB compared with TAP block during cesarean section surgery and in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions. Patients and Methods After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, female patients were included in the study, and were divided into two groups (n = 25; each); group QLB and group TAP. Group QLB: Patients (n = 25) of this group received bilateral ultrasound-guided QLB after induction of spinal anesthesia using (2-2.5 mg/kg of bupivacaine not to exceed 175 mg per dose and maximum 400mg/24h) without exceeding the toxic dose 3 mg/kg. Group TAP: Patients (n = 25) of this group received bilateral ultrasound-guided TAP block after induction of spinal anesthesia using (2-2.5 mg/kg of bupivacaine not to exceed 175 mg per dose and maximum 400mg/24h) without exceeding the toxic dose 3 mg/kg. Results The present study showed that the quadratus lumborum block was more efficient than the tansversus abdominis plane block. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (visual analog scale) indicated that the superiority of the QL block technique over the TAP block technique. The patients of group TAB had higher pain scores and were the first to ask for rescue analgesia; therefore, they had highest total pethidine consumption in the first 24 hours postoperatively in comparison to patients of group QLB. This is mainly due to the extension of the local anesthetic agent in QLB beyond the transverse abdominal plane to the thoracic paravertebral space, which then results in more analgesia, even somatic and visceral pain control. Conclusion Quadratus lumborum block was the most effective technique in providing analgesia after cesarean section in comparison to transversus abdominis plane block and even more time covering to rescue opioid.