Quadratus lumborum block for postoperative analgesia: a systematic review and meta-analysis
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Quadratus lumborum block for postoperative analgesia: a systematic review and meta-analysis Bloc du muscle du carre´ des lombes (quadratus lomburum) pour l’analge´sie postope´ratoire : revue syste´matique et me´ta-analyse . Susanne Retter, MD . Emma Kehoe, MD . Vishal Uppal, MBBS, MSc, FRCA Dolores M. McKeen, MD, MSc, FRCPC Received: 1 October 2019 / Revised: 29 June 2020 / Accepted: 29 June 2020 Ó Canadian Anesthesiologists’ Society 2020
Abstract Purpose The goal of the present systematic review is to determine the efficacy of the quadratus lumborum block (QLB) in providing postoperative analgesia for abdominal wall and hip surgeries when compared with placebo or other analgesic techniques. Methods Electronic databases (Medline, Embase, Cochrane Central, and Scopus) were searched for keywords and controlled vocabulary terms related to QLB from their inception to November 2019. The included studies compared ultrasound-guided singleinjection QLB to placebo and other analgesic techniques in adult patients. Results Forty-two randomized-controlled trials provided the data for this systematic review. Eight studies were assessed as high risk of bias in at least one domain. The included studies had significant heterogeneity with regard to the type of surgery, comparator groups, and outcomes measured; therefore, a limited quantitative analysis was undertaken for the comparison of QLB vs no block or placebo in patients undergoing Cesarean delivery only. For Cesarean delivery, the QLB reduced the opioid use by
Presented in part at the Annual Meeting of the American Society of Regional Anaesthesia, Las Vegas, USA, April 2019.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-020-01793-3) contains supplementary material, which is available to authorized users. V. Uppal, MBBS, MSc, FRCA (&) S. Retter, MD E. Kehoe, MD D. M. McKeen, MD, MSc, FRCPC Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Nova Scotia Health Authority and IWK Health Centre, Halifax, NS, Canada e-mail: [email protected]
24.1 (95% confidence interval, 17.3 to 30.9) mg oral morphine equivalents in the first postoperative 24 hr compared with no block or placebo with no difference in pain scores at rest. For other surgical procedures, the pain scores and opioid use were lower in the QLB group when compared with placebo or no regional anesthesia technique. When compared with other regional anesthetic techniques, the analgesic benefit of QLB was marginal. Conclusion Quadratus lumborum block provided analgesic benefits compared with placebo for use in the abdominal wall and hip surgery, with only marginal benefits compared with other regional analgesic techniques. The identified studies used different variants of QLB in many different surgery types. These findings and conclusions, therefore, should be considered preliminary. Trial registration PROSPERO (CRD42018095965); registered 6 June 2018. Re´sume´ Objectif L’objectif de cette
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