剖宫产术后后内侧腰方肌阻滞与切口局部浸润麻醉的比较：一项随机双盲对照研究

剖宫产术后后内侧腰方肌阻滞与切口局部浸润麻醉的比较：一项随机双盲对照研究

Posteromedial quadratus lumborum block versus wound infifiltration after caesarean section A randomised, double-blind, controlled study

Abstract

BACKGROUND Reducing pain and minimising opioids after caesarean section are crucial to enhancing maternal recovery and promoting mother-newborn interaction. Various techniques have been implemented to improve analgesia. We compared the analgesic effificacy of posteromedial quadratus lumborum block with that of wound infifiltration following elective caesarean section. 

OBJECTIVE We hypothesised that within a multimodal analgesia approach, posteromedial quadratus lumborum block would, due to its potential to relieve visceral pain, result in a 15% reduction in 24-h postoperative opioid consumption compared with wound infifiltration. 

DESIGN A double-blind, randomised, placebo-controlled clinical study. 

SETTING A single-centre study between August 2019 and May 2020. 

PATIENTS One hundred and sixteen women were randomly allocated into two groups. In the quadratus lumborum group, 20 ml 0.9% saline was injected into the surgical wound followed by bilateral posteromedial quadratus lumborum block using 20 ml 0.25% levobupivacaine per side. In the wound infifiltration group, 20 ml of 0.25% levobupivacaine was injected into the surgical wound followed by a bilateral posteromedial quadratus lumborum injection with 20 ml 0.9% saline per side.  

MAIN OUTCOME MEASURES The primary outcome was opioid (piritramide) consumption at 24 h. Secondary outcomes were piritramide consumption at 48 h, time-to-fifirst analgesic request, pain scores at rest and with movement, surgery-to-fifirst-ambulation time, surgery-to-breastfeeding time, sedation, pruritus and complications. 

RESULTS Piritramide consumption in 24 h was signifificantly lower with posteromedial quadratus lumborum block (1.5 1.8 mg) than with wound infifiltration (2.2 1.7 mg) (P ¼ 0.04), mean difference of -0.7 mg, (95% CI -1.3 to - 0.03). In those who required piritramide, time-to-fifirst analgesic request was signifificantly longer with posteromedial quadratus lumborum block 11 [7 to 14] h, than with wound infifiltration 7 [5 to 11] h (P ¼ 0.02). Pain scores were low, with no differences recorded at rest and with movement. There were no differences in time-to-ambulation and time-tobreastfeed between the groups. 

CONCLUSION As a component of multimodal postcaesarean section analgesia, posteromedial quadratus lumborum block was associated with lower 24-h opioid consumption compared with wound infifiltration. 

TRIAL REGISTRATION ClinicalTrials.gov identififier: NCT04000308