Work

Comparative efficacy of intrathecal morphine and posterior quadratus lumborum block for post-caesarean analgesia

Year: 2025

Type: article

Abstract: Background : Effective pain management after caesarean delivery is essential to promote maternal recovery, facilitate early mobility, and support mother-infant bonding. Traditionally, intrathecal morphine (ITM) has been widely used due to its strong analgesic effects, but concerns about opioid-related side effects have led to growing interest in alternative regional techniques such as the quadratus lumborum block (QLB). Comparative evidence on the efficacy of these approaches in obstetric patients remains limited. Methods In a randomized trial, 70 cesarean patients underwent spinal anesthetic at Assiut University Hospital. The study compared bilateral posterior QLB with 0.25% bupivacaine to 100 μg ITM. Secondary outcomes included pain scores, time to first morphine request, side effects, quality of recovery, and functional outcomes; the primary outcome was 24-hour IV morphine consumption. Results Morphine consumption over 24 hours was similar between the ITM and QLB groups, averaging 6.4 mg and 8.5 mg, respectively. Pain levels at rest and during movement did not differ significantly between the two groups at any time point. However, a subgroup analysis showed that QLB patients with a BMI of 30 kg/m² or higher required more morphine and reported higher peak pain scores compared to those in the ITM group (10.5 mg vs 7.4 mg, p < 0.05). No such difference was seen in patients with a BMI below 30 kg/m².In a multivariate analysis, BMI emerged as the only significant predictor of 24-hour morphine consumption (p = 0.016). Conclusion ITM and posterior QLB provide comparable postoperative analgesia after cesarean delivery for the general population. However, patient factors such as BMI and age may influence postoperative opioid requirements and should be considered when selecting an analgesic technique to optimize recovery and minimize side effects.

Source: Perioperative Care and Operating Room Management

DOI: 10.1016/j.pcorm.2025.100559

Authors: Ahmed Omar Mahmoud, Gamal Mohamed Abu Dahab Ibrahim, Mahmoud Alhasan Mohamed Hasan, Waleed Ahmad Ali Hussein Atteia, Ahmed Abdelkader Ahmed, Mostafa Hassanien Hassanien Bakr

Institutions: New Valley University, Assiut University, King Saud University

Language: English

Topic: Anesthesia and Pain Management

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $2,640