Analgesic Efficacy of Transversalis Fascia Plane Block Versus Anterior Quadratus Lumborum  Block after Caesarian Section

Muhammad Muzzamal Saleem; Abdul Hameed  Bhatti; Naveed  Farhat; Nabeel  Tahir; Muhammad Zeeshan  Akbar; Saad  Hameed

doi:10.51253/pafmj.v76iSUPPL-1.10689

Authors

Muhammad Muzzamal Saleem Department of Anesthesia, Combined Military Hospital Bahawalpur/National University of Medical Sciences (NUMS) Pakistan
Abdul Hameed Bhatti Department of Anesthesia, Pakistan Air Force Hospital, Islamabad Pakistan
Naveed Farhat Department of Anesthesia, Combined Military Hospital Bahawalpur/National University of Medical Sciences (NUMS) Pakistan
Nabeel Tahir Department of Anesthesia, Combined Military Hospital, Rahim Yar Khan/National University of Medical Sciences (NUMS) Pakistan
Muhammad Zeeshan Akbar Department of Anesthesia, Combined Military Hospital Bahawalpur/National University of Medical Sciences (NUMS) Pakistan
Saad Hameed Department of Anesthesia, Scouts Hospital Chitral, Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-1.10689

Keywords:

Analgesia, Anterior quadratus lumborum, Caesarian, Efficacy, Transversalis fascia plane

Abstract

Objective: To compare the post-operative analgesic efficacy of ultrasound guided transversalis fascia plane block (TFPB) with anterior quadratus lumborum block (QL) in patients undergoing caesarian section.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Anesthesia, Combined Military Hospital Bahawalpur, Pakistan from Jan to Jun 2023.

Methodology: Blocks were done bilaterally under ultrasound guidance following the standard aseptic techniques and protocols furnished by NYSORA at the end of surgery under general anesthesia. Primary variables measured were mean total 24-hour morphine consumption and median scores on the NRS scale at 3-, 6-, 12- and 24-hours interval.

Results: Cumulative mean dose of Morphine between group TFPB and QL was 3.09±0.50 mg versus 1.69±0.67 mg (p<0.001) at 3 hours post-op, 5.71±0.75 mg versus 3.77±0.73 mg (p<0.001) 6 hours post-op, 8.66±0.63 mg versus 7.49±0.50 (p<0.001) 12 hours post-op and 9.60±0.73 mg versus 8.29±0.92 mg (p<0.001) 24 hours post-operatively. Median pain scores on the numerical rating scale (NRS) between group TFPB and QL were 3.00 (IQR=0.00) versus 2.00 (IQR=1.00) at 3 hours post-op (p<0.001), 3.00 (IQR=0.00) versus 3.00 (IQR=1.00) 6 hours post-op (p=0.043), 3.00 (IQR=0.00) versus 3.00 (IQR=0.00) (p=0.772) 12 hours post-op and 3.00 (IQR=1.00) versus 3.00 (IQR=1.00) (p=0.812) 24 hours post-operatively.

Conclusion: Anterior QL block provides better analgesia efficacy and NRS scores during the first 12 hours post-delivery with comparable Morphine consumption and NRS scores versus TFPB between 12 and 24 hours.

Downloads

Download data is not yet available.

References

Betran AP, Ye J, Moller A-B, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health 2021; 6(6): e005671.

https://doi.org/10.1136/bmjgh-2021-005671

2. Landau R. Post-cesarean delivery pain. Management of the opioid-dependent patient before, during and after cesarean delivery. Int J Obstet Anesth 2019; 39: 105-116.

https://doi.org/10.1016/j.ijoa.2019.01.011

3. Xu M, Tang Y, Wang J, Yang J. Quadratus lumborum block for postoperative analgesia after cesarean delivery: a systematic review and meta-analysis. Int J Obstet Anesth 2020; 42: 87-98.

https://doi.org/10.1016/j.ijoa.2020.02.005

4. Roofthooft E, Joshi G, Rawal N, Van de Velde M. Guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations. Anaesth 2021; 76(5): 665-680.

https://doi.org/10.1111/anae.15339

5. Jemal B, Mohammed F, Tesema HG, Ahmed S, Mohammed A, Regasa T, et al. Analgesic Efficacy of Spinal Morphine in Comparison With Transversus Abdominis Plane Block for Postoperative Pain Management in Patients Undergoing Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial. Front Med 2022; 9: 814538.

https://doi.org/10.3389/fmed.2022.814538

6. Machi A, Joshi GP. Interfascial plane blocks. Best Pract Res Clin Anaesthesiol 2019; 33(3): 303-315.

https://doi.org/10.1016/j.bpa.2019.08.001

7. Wen-Li Z, Shao-Dong L, Wu B, Zhen-Feng Z. Quadratus lumborum block is an effective postoperative analgesic technique in pediatric patients undergoing lower abdominal surgery: A meta-analysis. Pain Physician 2021; 24(5): E555-E563.

8. Elsharkawy H, El-Boghdadly K, Barrington M. Quadratus lumborum block: anatomical concepts, mechanisms, and techniques. Anesthesiol 2019; 130(2): 322-335.

https://doi.org/10.1097/aln.0000000000002524

9. Fouad AZ, Abdel-Aal IRM, Gadelrab MRMA, Mohammed HME-HS. Ultrasound-guided transversalis fascia plane block versus transmuscular quadratus lumborum block for post-operative analgesia in inguinal hernia repair. Korean J Pain 2021; 34(2): 201-209. https://doi.org/10.3344/kjp.2021.34.2.201

10. Bilgin S, Aygun H, Genc C, Dost B, Tulgar S, Kaya C, et al. Comparison of ultrasound-guided transversalis fascia plane block and anterior quadratus lumborum block in patients undergoing caesarean delivery: a randomized study. BMC Anesthesiol 2023; 23(1): 246.

https://doi.org/10.1186/s12871-023-02206-w

11. Shafshak TS, Elnemr R. The visual analogue scale versus numerical rating scale in measuring pain severity and predicting disability in low back pain. J Clin Rheumatol 2021; 27(7): 282-285. https://doi.org/10.1097/RHU.000000000000

12. Kadam VR, Van Wijk RM, Ludbrook GL, Thiruvenkatarajan V. Anatomical and ultrasound description of two transmuscular quadratus lumborum block approaches at L2 level and their application in abdominal surgery. Anaesth Intensive Care 2019; 47(2): 141-145.

https://doi.org/10.1177/0310057x19839931

13. Hadzic A. NYSORA Nerve Block Manual: NYSORA Inc.; 2022 Edition 1.

14. Huang J, Cao C, Nelson G, Wilson RD. A review of enhanced recovery after surgery principles used for scheduled caesarean delivery. J Obstet Gynaecol Can 2019; 41(12): 1775-1788.

https://doi.org/10.1016/j.jogc.2018.05.043

15. Mutuyimana M. Comparison between the use of intrathecal morphine and intravenous/subcutaneous/intramuscular morphine in the management of post-Caesarean section pain in University Teaching Hospital of Kigali and Muhima District Hospital. (Thesis): Kigali: University of Rwanda; 2021.

16. Tarek MA, Thabet GSM, Abdelmaboud A. Ultrasound-guided quadratus lumborum block versus transversus abdominis plane block for post-operative pain after caesarean delivery. Med J Cairo Univ 2022; 90(1): 91-97.

17. Bilgin S, Aygun H, Genc C, Dost B, Tulgar S, Kaya C, et al. Comparison of ultrasound-guided transversalis fascia plane block and anterior quadratus lumborum block in patients undergoing caesarean delivery: a randomized study. BMC Anesthesiol 2023; 23(1): 1-8.

https://doi.org/10.1186/s12871-023-02206-w

18. Wang J, Zhao G, Song G, Liu J. The efficacy and safety of local anesthetic techniques for postoperative analgesia after cesarean section: a Bayesian network meta-analysis of randomized controlled trials. J Pain Res 2021: 1559-1572.

https://doi.org/10.2147/jpr.s313972

19. Serifsoy TE, Tulgar S, Selvi O, Senturk O, Ilter E, Peker BH, et al. Evaluation of ultrasound-guided transversalis fascia plane block for postoperative analgesia in cesarean section: a prospective, randomized, controlled clinical trial. J Clin Anesth 2020; 59: 56-60. https://doi.org/10.1016/j.jclinane.2019.06.025

20. Chilkoti GT, Gaur D, Saxena AK, Gupta A, Agarwal R, Jain S et al. Ultrasound-guided transversalis fascia plane block versus wound infiltration for both acute and chronic post-caesarean pain management–A randomised controlled trial. Indian J Anaesth 2022; 66(7): 517-522.

https://doi.org/10.4103/ija.ija_173_22

21. Nair A, Dudhedia U, Rangaiah M, Borkar N. Ultrasound-guided transversalis fascia plane block for postoperative analgesia: A systematic review and meta-analysis. Indian J Anaesth 2023; 67(4): 331-342. https://doi.org/10.4103/ija.ija_43_23