Posterior quadratus lumborum block versus intrathecal morphine analgesia after scheduled cesarean section: a prospective, randomized, controlled study.
| Title: | Posterior quadratus lumborum block versus intrathecal morphine analgesia after scheduled cesarean section: a prospective, randomized, controlled study. |
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| Authors: | Giral T; Anaesthesia, Claude Galien Private Hospital, Quincy-sous-Senart, Île-de-France, France thomasgiral83@gmail.com.; Delvaux BV; Anaesthesia, Claude Galien Private Hospital, Quincy-sous-Senart, Île-de-France, France.; Huynh D; Anaesthesia, Claude Galien Private Hospital, Quincy-sous-Senart, Île-de-France, France.; Morel B; Anaesthesia, Claude Galien Private Hospital, Quincy-sous-Senart, Île-de-France, France.; Zanoun N; Anaesthesia, Claude Galien Private Hospital, Quincy-sous-Senart, Île-de-France, France.; Ehooman F; Anaesthesia, Claude Galien Private Hospital, Quincy-sous-Senart, Île-de-France, France.; Garnier T; Anaesthesia, Claude Galien Private Hospital, Quincy-sous-Senart, Île-de-France, France.; Maupain O; Anaesthesia, Claude Galien Private Hospital, Quincy-sous-Senart, Île-de-France, France. |
| Source: | Regional anesthesia and pain medicine [Reg Anesth Pain Med] 2026 Jan 05; Vol. 51 (1), pp. 82-89. Date of Electronic Publication: 2026 Jan 05. |
| Publication Type: | Journal Article; Randomized Controlled Trial; Comparative Study; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: BMJ Country of Publication: England NLM ID: 9804508 Publication Model: Electronic Cited Medium: Internet ISSN: 1532-8651 (Electronic) Linking ISSN: 10987339 NLM ISO Abbreviation: Reg Anesth Pain Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2018- : [London, United Kingdom] : BMJ; Original Publication: Secaucus, NJ : Churchill Livingstone, c1998- |
| MeSH Terms: | Morphine*/administration & dosage ; Morphine*/adverse effects ; Cesarean Section*/adverse effects ; Nerve Block*/methods ; Nerve Block*/adverse effects ; Postoperative Pain*/prevention & control ; Postoperative Pain*/diagnosis ; Postoperative Pain*/etiology ; Analgesics, Opioid*/administration & dosage ; Analgesics, Opioid*/adverse effects ; Analgesia, Obstetrical*/methods ; Analgesia, Obstetrical*/adverse effects; Pain Measurement/methods ; Humans ; Female ; Prospective Studies ; Adult ; Pregnancy ; Injections, Spinal ; Treatment Outcome |
| Abstract: | Background: During the postoperative period of elective cesarean section, intrathecal morphine is effective in the multimodal analgesic regimen, but can cause significant adverse effects. Bilateral posterior quadratus lumborum block could be alternatively used. The aim of this study was to compare efficacy and safety of both strategies as part of a multimodal analgesic regimen.; Methods: This was a prospective, randomized, blinded, controlled study. 104 parturients were randomly selected to receive intrathecal morphine or posterior quadratus lumborum block during cesarean section under spinal anesthesia. The primary endpoint was patient-controlled 24-hour cumulative intravenous morphine use. Secondary endpoints were 48-hour cumulative morphine use, static/dynamic pain scores, functional recovery (ObsQoR-11 questionnaire) and adverse effects.; Results: There was no statistical difference in the mean cumulative morphine dose at 24-hour between groups (posterior quadratus lumborum block group, 13.7 (97.5% CI 10.4 to 16.9) mg; intrathecal morphine group, 11.1 (97.5% CI 8.4 to 13.8) mg, p=0.111). Pain scores did not show any difference between groups, excepted at 6 hours for the pain at cough/movement in favor of the posterior quadratus lumborum block group (p=0.013). A better recovery quality was observed at 24 hours in the posterior quadratus lumborum block group (p=0.009). Pruritus was more frequent in intrathecal morphine group parturients (35% vs 2%) CONCLUSIONS: No difference in cumulative morphine dose at 24 hours was observed in posterior quadratus lumborum block group compared with intrathecal morphine group. Posterior quadratus lumborum block can be considered an alternative to intrathecal morphine in cesarean postoperative analgesia, especially in cases of intolerance to morphine.; Trial Registration Number: NCT04755712.; (© American Society of Regional Anesthesia & Pain Medicine 2026. No commercial re-use. See rights and permissions. Published by BMJ Group.) |
| Competing Interests: | Competing interests: None declared. |
| Contributed Indexing: | Keywords: Analgesia; Nerve Block; Obstetrics; Opioids; Pain, Postoperative |
| Molecular Sequence: | ClinicalTrials.gov NCT04755712 |
| Substance Nomenclature: | 76I7G6D29C (Morphine); 0 (Analgesics, Opioid) |
| Entry Date(s): | Date Created: 20240905 Date Completed: 20260106 Latest Revision: 20260220 |
| Update Code: | 20260221 |
| DOI: | 10.1136/rapm-2024-105454 |
| PMID: | 39237149 |
| Database: | MEDLINE |
Journal Article; Randomized Controlled Trial; Comparative Study; Research Support, Non-U.S. Gov't