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Research article
Pawinee Pangthipampai
Mahidol University Faculty of Medicine Siriraj Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2574-7667
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Achieving optimal abdominal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal morphine is the current standard but ultrasound guided quadratus lumborum block (US-QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine 0.2 mg, with IT morphine 0.2 mg and bilateral QLB, or only bilateral QLB.
Methods: Parturients having elective cesarean delivery with a low transverse incision under spinal block were randomized to three groups. Subjects were allocated into IT morphine 0.2 mg with sham QLB (Group IT morphine), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml and adrenaline 1:250,000 in each side (Group IT morphine with QLB), or bilateral QLB with 0.25% bupivacaine 25 ml and adrenaline 1:250,000 in each side (Group QLB). A PCA pump was connected to each parturient after completion of the QLB or sham block. The first time to PCA morphine requirement when parturients experienced pain was recorded and compared.
Results: Eighty parturients were included. Analysis of Group QLB was terminated early because Kaplan-Meier survival analysis showed the median pain-free period to be significantly shorter in Group QLB at the second interim analysis; [2.50 hours (95% CI: 1.04-3.96) in Group IT morphine vs. 7.75 (95% CI: 5.67-9.83) in Group IT morphine with QLB vs. 1.75 (95% CI: 0.75-2.75) in Group QLB (overall p<0.001)]. The median (min, max) amount of morphine required during 24 hours was 5.5 (0-25) in Group IT morphine vs. 5.0 (0-36) in Group IT morphine with QLB vs. 17.5 (1-40) mg in Group QLB (p<0.001). In the final analysis the median pain-free period was 2.50 hours (95%CI: 1.23-3.77) in Group IT morphine (n=27) and 8.02 (95%CI: 5.96-10.07) in Group IT morphine with QLB (n=28). (Gehan-Breslow p=0.027).
Conclusion: US-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB may provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period.
Trial registration: ClinicalTrials.gov no. NCT03199170 Date registered on June 22, 2017. Prospectively registered.
Keywords
Bilateral posterior quadratus lumborum block, ultrasound-guided QLB, pain relief, cesarean delivery
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On 19 Jan, 2021
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On 17 Jan, 2021
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On 13 Jan, 2021
Editor invited
On 13 Jan, 2021
No comments provided
Editorial decision: Major revision
On 14 Dec, 2020
Review #2 received
Received 13 Dec, 2020
Review #1 received
Received 29 Nov, 2020
Reviewer #2 agreed
On 23 Nov, 2020
Reviewers invited
Invitations sent on 21 Nov, 2020
Reviewer #1 agreed
On 21 Nov, 2020
Editor assigned
On 17 Nov, 2020
Submission checks complete
On 17 Nov, 2020
Editor invited
On 17 Nov, 2020
Version 1
Posted 25 Jun, 2020
No comments provided
Editorial decision: Major revision
On 19 Oct, 2020
Review #2 received
Received 22 Sep, 2020
Review #1 received
Received 04 Aug, 2020
Reviewer #1 agreed
On 15 Jul, 2020
Reviewer #2 agreed
On 15 Jul, 2020
Reviewers invited
Invitations sent on 02 Jul, 2020
Editor assigned
On 01 Jul, 2020
Submission checks complete
On 24 Jun, 2020
Editor invited
On 24 Jun, 2020
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Subject Areas
Anesthesiology & Pain Medicine
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See the published version of this preprint at BMC Anesthesiology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Pawinee Pangthipampai
Mahidol University Faculty of Medicine Siriraj Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2574-7667
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Anesthesiology.
No community comments so far
Review #2 received
Received 03 Feb, 2021
Editorial decision: Minor revision
On 03 Feb, 2021
Review #1 received
Received 20 Jan, 2021
Reviewer #2 agreed
On 19 Jan, 2021
Reviewers invited
Invitations sent on 17 Jan, 2021
Reviewer #1 agreed
On 17 Jan, 2021
Editor assigned
On 13 Jan, 2021
Submission checks complete
On 13 Jan, 2021
Editor invited
On 13 Jan, 2021
No comments provided
Editorial decision: Major revision
On 14 Dec, 2020
Review #2 received
Received 13 Dec, 2020
Review #1 received
Received 29 Nov, 2020
Reviewer #2 agreed
On 23 Nov, 2020
Reviewers invited
Invitations sent on 21 Nov, 2020
Reviewer #1 agreed
On 21 Nov, 2020
Editor assigned
On 17 Nov, 2020
Submission checks complete
On 17 Nov, 2020
Editor invited
On 17 Nov, 2020
Version 1
Posted 25 Jun, 2020
No comments provided
Editorial decision: Major revision
On 19 Oct, 2020
Review #2 received
Received 22 Sep, 2020
Review #1 received
Received 04 Aug, 2020
Reviewer #1 agreed
On 15 Jul, 2020
Reviewer #2 agreed
On 15 Jul, 2020
Reviewers invited
Invitations sent on 02 Jul, 2020
Editor assigned
On 01 Jul, 2020
Submission checks complete
On 24 Jun, 2020
Editor invited
On 24 Jun, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Anesthesiology.
Background: Achieving optimal abdominal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal morphine is the current standard but ultrasound guided quadratus lumborum block (US-QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine 0.2 mg, with IT morphine 0.2 mg and bilateral QLB, or only bilateral QLB.
Methods: Parturients having elective cesarean delivery with a low transverse incision under spinal block were randomized to three groups. Subjects were allocated into IT morphine 0.2 mg with sham QLB (Group IT morphine), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml and adrenaline 1:250,000 in each side (Group IT morphine with QLB), or bilateral QLB with 0.25% bupivacaine 25 ml and adrenaline 1:250,000 in each side (Group QLB). A PCA pump was connected to each parturient after completion of the QLB or sham block. The first time to PCA morphine requirement when parturients experienced pain was recorded and compared.
Results: Eighty parturients were included. Analysis of Group QLB was terminated early because Kaplan-Meier survival analysis showed the median pain-free period to be significantly shorter in Group QLB at the second interim analysis; [2.50 hours (95% CI: 1.04-3.96) in Group IT morphine vs. 7.75 (95% CI: 5.67-9.83) in Group IT morphine with QLB vs. 1.75 (95% CI: 0.75-2.75) in Group QLB (overall p<0.001)]. The median (min, max) amount of morphine required during 24 hours was 5.5 (0-25) in Group IT morphine vs. 5.0 (0-36) in Group IT morphine with QLB vs. 17.5 (1-40) mg in Group QLB (p<0.001). In the final analysis the median pain-free period was 2.50 hours (95%CI: 1.23-3.77) in Group IT morphine (n=27) and 8.02 (95%CI: 5.96-10.07) in Group IT morphine with QLB (n=28). (Gehan-Breslow p=0.027).
Conclusion: US-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB may provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period.
Trial registration: ClinicalTrials.gov no. NCT03199170 Date registered on June 22, 2017. Prospectively registered.
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
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