Publications

Abstract
Original Article
I ntroductIon
Multimodal analgesia is the standard of care in any acute
postoperative pain relief regimen. Regional blocks have
become the mainstay of perioperative pain management.
Transversus abdominis plane (TAP) block and quadratus
lumborum (QL) block provide effective postoperative
pain relief and minimize opioid intake in patients
undergoing major abdominal surgery.[1] There are many
studies published comparing TAP and QL blocks using
0.25% bupivacaine in abdominal surgeries. There is a
need to understand the efficacy of these blocks in terms of
postoperative analgesia using lower concentration of local
anesthetic agents to reduce the total dose used and thereby
its side effects.
We conducted a study to compare the efficacy of
ultrasonography (USG)‑guided bilateral QL1 block versus
USG‑guided bilateral TAP block with lower concentration of
bupivacaine (0.125%) and dexamethasone for postoperative
analgesia in patients undergoing lower‑segment cesarean
Background and Objectives: The study sought to compare the postoperative analgesia after ultrasonography (USG)‑guided bilateral
transversus abdominis plane (TAP) block versus quadratus lumborum (QL) 1 block with lower concentration of bupivacaine in patients
undergoing lower‑segment cesarean section (LSCS). Materials and Methods: A randomized controlled trial was conducted at a tertiary
hospital, Bengaluru, from 2019 to 2021. Fifty‑six patients belonging to the American Society of Anesthesiologists physical status Class I and
II aged 20–40 years posted for LSCS under subarachnoid block were divided into two groups. Patients in Group I were given bilateral TAP
block and patients in Group II were given bilateral QL1 block under USG guidance at the end of surgery using 0.125% bupivacaine (20 ml)
and 4 mg dexamethasone. Patients were monitored for postoperative pain with Numerical Pain Intensity Scale (NPIS) at 0, 1, 4, 8, 12, and
24 h. Rescue analgesic was given if NPIS score was 6 or more. Time to first dose of rescue analgesic was noted. NPIS scores and time to
rescue analgesic were compared using independent t test. P < 5% was considered statistically significant. Results: Average NPIS scores
were less at 0, 1, and 4 h (<6) and higher at 8, 12, and 24 h in both the groups postoperatively. NPIS scores at 8 h were significantly higher
in Group I compared to Group II (P = 0.02). Time to first dose of rescue analgesic was 7.32 h in Group I and 9.07 h in Group II (P < 0.001).
Conclusions: Postoperative analgesia was better with USG‑guided QL1 block versus USG‑guided TAP block with 0.125% bupivacaine and
4 mg dexamethasone in patients undergoing LSCS.
Keywords: Bupivacaine, cesarean section, postoperative pain, ultrasonography