This two-centre, double-blind randomised trial in 58 women compared intrathecal morphine, a lateral quadratus lumborum (QL) block, and their combination for analgesia and recovery after Caesarean delivery.
Noninferiority of the QL block versus intrathecal morphine for 24-hour quality of recovery was inconclusive, so the block does not clearly replace morphine. But the QL block reduced resting pain at 6 hours compared with morphine alone (mean difference 2.9, 95% CI 1.3 to 4.5), and adding the block to morphine reduced resting pain (3.3), coughing pain (3.0) at 6 hours and worst pain at 24 hours (1.8) versus morphine alone. Opioid use and nausea did not differ; pruritus was more frequent with the block but mostly mild.
In practice this positions the QL block as an add-on rather than a substitute: intrathecal morphine remains the backbone, and the block is worth adding where early dynamic pain — coughing, moving, feeding — is hard to control. It is a small trial, so treat the size of benefit cautiously.
- QL block did not clearly replace intrathecal morphine (noninferiority inconclusive)
- Adding QL block to morphine cut early resting, coughing and 24-hour worst pain
- Opioid consumption and nausea unchanged; more mild pruritus with the block
- Use it as an add-on for difficult early dynamic pain, not as a morphine substitute
The statistics, in plain English
The inconclusive noninferiority result means the trial could not confirm the block is as good as morphine for overall recovery — an underpowered 58-patient study cannot rule out a meaningful difference either way. The significant pain differences at 6 hours are more reliable because pain scores are more sensitive than a composite recovery score, but the absolute numbers come from few patients.
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