This two-centre, randomised, double-blind trial compared intrathecal morphine, lateral quadratus lumborum block, and both together after Caesarean delivery, in 58 women analysed.
The primary question — whether the block was non-inferior to intrathecal morphine for quality of recovery at 24 hours — came back inconclusive, with a mean difference of -0.9 and a 90% interval from -0.9 to 13.5. That is the headline result and it is a null one.
The secondary findings are where the practical content sits. The block reduced resting pain at six hours by 2.9 points against intrathecal morphine. Adding the block to intrathecal morphine reduced resting pain at six hours by 3.3 points, coughing pain at six hours by 3.0, and worst pain at 24 hours by 1.8, all against morphine alone. Oxycodone consumption and nausea did not differ. Pruritus was more common with the block-containing arms but predominantly mild.
Fifty-eight women is small, and the authors say larger trials are needed. But the direction is consistent across three separate pain measures, and coughing pain at six hours after a Caesarean is not an abstract endpoint — it is whether a woman can hold and feed her baby comfortably on the first day.
- Consider adding a lateral quadratus lumborum block to intrathecal morphine where early pain is the problem.
- The recovery-score comparison was inconclusive, not positive: do not present the block as proven equivalent.
- Warn about pruritus with the block-containing regimens, though it was mostly mild.
- Opioid consumption did not differ, so this is a comfort argument rather than an opioid-sparing one.
- Fifty-eight women in two centres — treat the effect sizes as provisional.
The statistics, in plain English
Inconclusive is not the same as negative, and this trial shows why the distinction matters. A non-inferiority test asks whether the new option is no worse than the standard by more than a pre-set margin; with a 90% interval running from -0.9 to 13.5, the data are compatible with the block being better, the same, or meaningfully worse, so nothing is established either way. That usually means the trial was too small, and 58 women is small. The secondary pain differences do have intervals clear of zero — 1.3 to 4.5 for resting pain at six hours — but secondary outcomes in a trial whose primary endpoint was inconclusive are hypothesis-generating, not confirmatory. The consistency across three separate pain measures is what gives them weight, not any individual p value.
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