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CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(12): 1083-1089
DOI: 10.1055/s-0042-1759728
Original Article | Artigo Original
Obstetrics

Randomized Clinical Trial Comparing Quadratus Lumborum Block and Intrathecal Morphine for Postcesarean Analgesia

Ensaio Clínico Randomizado Comparando Bloqueio do Quadrado Lombar e Morfina Intratecal Para Analgesia Pós-cesariana
Karoline Moura de Araújo 
1   Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Leonardo Henrique Cunha Ferraro 
1   Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Sue Yasaki Sun 
1   Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Rosiane Mattar 
1   Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Abstract

Objective To compare the efficacy of quadratus lumborum (QL) block and intrathecal morphine (M) for postcesarean delivery analgesia.

Methods Thirty-one pregnant women with ≥ 37 weeks of gestation submitted to elective cesarean section were included in the study. They were randomly allocated to either the QL group (12.5 mg 0.5% bupivacaine for spinal anesthesia and 0.3 ml/kg 0.2% bupivacaine for QL block) or the M group (12.5 mg bupivacaine 0.5% and 100 mcg of morphine in spinal anesthesia). The visual analog scale of pain, consumption of morphine and tramadol for pain relief in 48 hours, and side effects were recorded.

Results Median pain score and/or pain variation were higher in the morphine group than in the QL group (p = 0.02). There was no significant difference in the consumption of morphine or tramadol between groups over time. Side effects such as pruritus, nausea, and vomiting were observed only in the morphine group.

Conclusion Quadratus lumborum block and intrathecal morphine are effective for analgesia after cesarean section. Patients undergoing QL block had lower postoperative pain scores without the undesirable side effects of opioids such as nausea, vomiting, and pruritus.

Resumo

Objetivo Comparar a eficácia do bloqueio do quadrado lombar (QL) e da morfina intratecal (M) na analgesia pós-cesariana.

Métodos Trinta e uma gestantes com ≥ 37 semanas de gestação submetidas a cesariana eletiva foram incluídas no estudo. Eles foram alocados aleatoriamente no grupo QL (12,5 mg de bupivacaína a 0,5% para raquianestesia e 0,3 ml/kg de bupivacaína a 0,2% para bloqueio de QL) ou no grupo M (12,5 mg de bupivacaína a 0,5% e 100 mcg de morfina na raquianestesia). A escala visual analógica de dor, consumo de morfina e tramadol para alívio da dor em 48 horas e efeitos colaterais foram registrados.

Resultados A mediana do escore de dor e/ou variação da dor foi maior no grupo morfina do que no grupo QL (p = 0,02). Não houve diferença significativa no consumo de morfina ou tramadol entre os grupos ao longo do tempo. Efeitos colaterais como prurido, náuseas e vômitos foram observados apenas no grupo morfina.

Conclusão O bloqueio QL e a morfina intratecal são eficazes para analgesia após cesariana. Os pacientes submetidos ao bloqueio do QL apresentaram menores escores de dor pós-operatória sem os efeitos colaterais indesejáveis dos opioides, como náuseas, vômitos e prurido.

Keywords

analgesia - cesarean section - morphine - spinal anesthesia - anestesia - obstetrical

Palavras-chave

analgesia - cesariana - morfina - anestesia espinhal - anestesia obstétrica

Contributors

All authors participated in the concept and design of the present study; analysis and interpretation of data; draft or revision of the manuscript; and they have approved the manuscript as submitted. All authors are responsible for the reported research.




Publication History

Received: 06 April 2022

Accepted: 08 September 2022

Article published online:
29 December 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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