Giral Thomas, Delvaux Bernard Victor, Huynh Davy, Morel Bertrand, Zanoun Nabil, Ehooman Franck, Garnier Thierry, Maupain Olivier
Anaesthesia, Claude Galien Private Hospital, Quincy-sous-Senart, Île-de-France, France
Anaesthesia, Claude Galien Private Hospital, Quincy-sous-Senart, Île-de-France, France.
Reg Anesth Pain Med. 2024 Sep 4. doi: 10.1136/rapm-2024-105454.
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.
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.
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.
NCT04755712.
在择期剖宫产术后阶段，鞘内注射吗啡在多模式镇痛方案中有效，但会引起显著的不良反应。双侧腰方肌阻滞可作为替代方法。本研究的目的是比较两种策略作为多模式镇痛方案一部分的疗效和安全性。
这是一项前瞻性、随机、双盲、对照研究。104名产妇在腰麻下行剖宫产时被随机选择接受鞘内注射吗啡或腰方肌阻滞。主要终点是患者自控的24小时静脉注射吗啡累积用量。次要终点是48小时吗啡累积用量、静态/动态疼痛评分、功能恢复（ObsQoR-11问卷）和不良反应。
两组之间24小时的平均吗啡累积剂量无统计学差异（腰方肌阻滞组，13.7（97.5%可信区间10.4至16.9）mg；鞘内注射吗啡组，11.1（97.5%可信区间8.4至13.8）mg，p = 0.111）。除了咳嗽/活动时疼痛在6小时时腰方肌阻滞组更有优势（p = 0.013）外，两组之间疼痛评分没有差异。腰方肌阻滞组在24小时时观察到更好的恢复质量（p = 0.009）。鞘内注射吗啡组产妇瘙痒更频繁（35%对2%）。结论：与鞘内注射吗啡组相比，腰方肌阻滞组24小时吗啡累积剂量无差异。腰方肌阻滞可被认为是剖宫产术后镇痛中鞘内注射吗啡的替代方法，尤其是在对吗啡不耐受的情况下。
NCT04755712。
