Quadratus lumborum block added to intrathecal morphine lowered early pain after caesarean

Design

Randomised, double-blind, placebo-controlled, two-centre trial

Population

58 women having caesarean delivery under spinal anaesthesia

Primary outcome

Quality of recovery (QoR-40) at 24 hours

Effect

QLB vs ITM inconclusive; ITM+QLB vs ITM: resting pain at 6 h 3.3 points lower (95% CI 1.9–4.8)

A two-centre, double-blind trial randomised women having caesarean delivery under spinal anaesthesia to bilateral lateral quadratus lumborum block (20 mL 0.5% ropivacaine each side), intrathecal morphine 100 µg with a sham block, or both. The primary outcome was quality of recovery at 24 hours.

Only 58 women were analysed, and the primary comparison between block and intrathecal morphine was inconclusive. The block alone reduced resting pain at six hours compared with intrathecal morphine. The combination reduced resting and coughing pain at six hours and worst pain at 24 hours compared with intrathecal morphine alone. Opioid use and nausea did not differ; pruritus was more common in the block groups but mostly mild.

The trial is small and its primary outcome did not answer the question it set, so the pain differences are secondary findings. Intrathecal morphine remains the standard. The block may be worth considering where intrathecal morphine is contraindicated, or as an addition when early pain is a concern and expertise is available. It was published in July 2026.

• Keep intrathecal morphine as the standard for analgesia after caesarean under spinal anaesthesia.
• Consider a quadratus lumborum block when intrathecal morphine is not possible.
• A block added to intrathecal morphine may reduce early pain; the evidence is from a small trial.
• Weigh the extra procedure, local anaesthetic dose and time against a modest early benefit.

Why it matters

Early pain after caesarean affects mobilisation and bonding, and intrathecal morphine is not always possible.

Don't overread it

The primary outcome was inconclusive in 58 women, so the pain benefits are secondary findings.

The statistics, in plain English

The recovery-score interval was too wide to decide whether the block was as good as intrathecal morphine. The pain differences of 2–3 points on a 0–10 scale are clinically meaningful, but secondary outcomes in a small trial are more likely to be chance findings or overestimates.

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