American Society of Regional Anesthesia and Pain Medicine May 2018 - 28

"In the past few years, discussion and use of truncal blocks for Cesarean delivery has gained popularity. This is based on witnessed
suboptimal pain relief that women endure after the procedures. Given that approximately one-third of all births are via Caesarean
delivery every year in the United States, this issue poses a significant public health problem that we must not ignore.
With the use of ultrasound, we have improved our anatomical knowledge of the abdominal wall and have been able to understand
that newly nominated fascial blocks can provide significant improvement in acute pain management. The blocks are starting to
prove themselves as long lasting options for pain relief and are an important addendum to the multimodal approach we practice on
daily basis. They should be given consideration as the gold standard of pain management.
In this issue, the authors recapitulate about different approaches and what clinical data has been published to date. There is no
point in sailing deep into the waters of different mechanisms of action. The blocks are clinically proven as effective, simple, and
safe with a clear effect on the speed of recovery, including earlier ambulation and decreased length of hospital stay.
We must maximize women's postoperative pain relief while minimizing side effects of our interventions. No matter whether you
consider yourself a regionalist or a generalist, learning these techniques will be worth it."
-Rafael Blanco

CONCLUSIONS
Results of the QLB for post-Cesarean pain are promising and
preliminarily appear to show that QLB outperforms the TAP block
while avoiding any known additional risk. While the QLB gains
momentum, what is yet to be determined is the ideal approach,
the feasibility of service, and the effect on more long-term pain
outcomes and quality-of-life markers for obstetric patients.
Furthermore, combinations of IT or epidural morphine and QLBs
remain a future area of study.
Regional anesthesia experts have much to contribute to obstetric
anesthesia, and we must continue to strive for opioid-minimizing
techniques in post-Cesarean section patients. We owe it to this group
of generally healthy, youthful, and opioid-naive patients to optimize
their postdelivery experience as they transition into a new role in life.
REFERENCES
1.

Quinlan JD, Murphy NJ. Cesarean delivery: counseling issues and complication
management. Am Fam Physician. 2015;91(3):178-184.

2.

Committee on Obstetric Practice. Committee opinion no. 666: optimizing
postpartum care. Obstet Gynecol. 2016;127:e187-e192.

3.

Niklasson B, Ohman S, Segerdahl M, Blanck A. Risk factors for persistent pain
and its influence on maternal wellbeing after Cesarean section. Acta Obstet
Gynecol Scand. 2015;94(6):622-628.

4.

Nikolajsen L, Sørensen HC, Jensen TS, Kehlet H. Chronic pain following
Cesarean section. Acta Anaesthesiol Scand. 2004;48(1):111-116.

5.

Lavand'homme P. Postcesarean analgesia: effective strategies and association
with chronic pain. Curr Opin Anaesthesiol. 2006;19(3):244-248.

6.

Blanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative
pain after Cesarean section: a randomized controlled trial. Eur J Anaesthesiol.
2015;32(11):812-818.

28

7.

Abdallah FW, Laffey JG, Halpern SH, Brull R. Duration of analgesic effectiveness
after the posterior and lateral transversus abdominis plane block techniques
for transverse lower abdominal incisions: a meta-analysis. Br J Anaesth.
2013;111(5):721-735.

8. Mukhtar K. Transversus abdominis plane (TAP) block. J NYSORA. 2009;12:
28-33.
9.

Telnes A, Skogvoll E, Lonnée H. Transversus abdominis plane block vs. wound
infiltration in Cesarean section: a randomised controlled trial. Acta Anaesthesiol
Scand. 2015;59(4):496-504.

10. Mishriky BM, George RB, Habib AS. Transversus abdominis plane block for
analgesia after Cesarean delivery: a systematic review and meta-analysis. Can J
Anaesth. 2012;59(8):766-778.
11. Kanazi GE, Aouad MT, Abdallah FW, et al. The analgesic efficacy of subarachnoid
morphine in comparison with ultrasound-guided transversus abdominis plane
block after cesarean delivery: a randomized controlled trial. Anesth Analg.
2010;111(2):475-481.
12. Loane H, Preston R, Douglas MJ, Massey S, Papsdorf M, Tyler J. A randomized
controlled trial comparing intrathecal morphine with transversus abdominis
plane block for post-cesarean delivery analgesia. Int J Obstet Anesth.
2012;21(2):112-118.
13. McMorrow RC, Mhuricheartaigh RJ, Ahmed, KA, et al. Comparison of transversus
abdominis plane block vs spinal morphine for pain relief after Cesarean section.
Br J Anaesth. 2011;106(5):706-712.
14. Blanco R. Tap block under ultrasound guidance: the description of a "no pops"
technique (abstract 271). Reg Anesth Pain Med. 2007;32(suppl 1):130.
15. Ueshima H, Otake H, Lin JA. Ultrasound-guided quadratus lumborum block: an
updated review of anatomy and techniques. BioMed Res Int. 2017;2017:1-7.
16. Elsharkawy H. Ultrasound-guided quadratus lumborum block: how do I do it?
ASRA News. 2015;15(4):36-44.
17. Blanco R, Ansari T, Raid W, Shetty N. Quadratus lumborum block versus
transversus abdominis plane block for postoperative pain after cesarean
delivery: a randomized controlled trial. Reg Anesth Pain Med. 2016;41(6):
757-762.

American Society of Regional Anesthesia and Pain Medicine
2018



Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine May 2018

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