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Transmuscular quadratus lumborum blockade after elective cesarean delivery to improve recovery outcomes: A quality improvement project
Abstract Number: S2B-5
Abstract Type: Original Research
Introduction: The quadratus lumborum block (QLB) is an emerging analgesic option for cesarean delivery (CD) that we introduced in our institution as part of a quality improvement project to improve outcomes for women on our enhanced recovery pathway. We evaluated whether the introduction of a transmuscular QLB service following elective CD could improve postoperative analgesia and recovery outcomes compared to routine care.
Methods: This quality improvement project analysis received IRB exemption. We present the data for fifteen women who received a QLB following their elective CD provided by our novel QLB service. Women received a standard multimodal analgesic regime: 12.5 mg bupivacaine and 300 mcg diamorphine intrathecally, rectal diclofenac, regular oral paracetamol and ibuprofen plus dihydrocodine and oral morphine as required. QLB was performed with 20 mL 0.25% bupivacaine per side under ultrasound guidance. Local enhanced recovery practice was followed and analgesic outcomes (24 hr morphine consumption, time to first analgesic request, numerical pain scores (0-100) at 4, 8 and 24 hrs) and 24 hr quality of recovery scores (11 questions about pain, mobilisation, ability to nurse baby, and side-effects in an 11-point numerical Likert scale 0-10, maximum score 110) were completed and compared to baseline enhanced recovery audit data collected prior to introduction of the QLB service. Data is presented as median [IQR] and compared using Mann Whitney U test for continuous non-parametric data and Chi squared test for categorical data. A p value <0.05 was considered significant.
Results: Spinal and QLB (n=15) was compared to standard regime (spinal and no QLB; n=49). Baseline characteristics were similar between groups. Pain scores on movement in women who received a QLB were: 1 [0-10], 2.5 [0-11], and 25 [10-50] at 4, 8 and 24 hrs respectively. Table 1 summarises the comparative results.
Discussion: Transmuscular QLB appears to be a useful adjunct for elective CD. Adding it to our current practice has reduced opioid requirement, prolonged analgesia and improved functional recovery. Controlled studies are required to further elucidate the potential benefit in this patient cohort.
1. Blanco R et al. Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial. Eur J Anaesthesiol. 2015; 32: 812-8
2. Borglum J et al. Ultrasound-guided transmuscular quadratus lumborum blockade. BJA. 2013; 111: eLetters supplement