Comparison of erector spinae plane block versus quadratus lumborum block for post-caesarean analgesia: Systematic...

Post-caesarean pain significantly impacts maternal recovery. The erector spinae plane (ESP) and quadratus lumborum block (QLB) are regional analgesic techniques used for postoperative pain management; however, their comparative effectiveness remains uncertain. The objective was to compare the efficacy of ESP and QLB regarding post-caesarean pain intensity, opioid consumption, time to first analgesic request, and the incidence of nausea and vomiting.

A systematic review and meta-analysis of randomised controlled trials comparing ESP and QLB in women undergoing caesarean section was conducted according to PRISMA guidelines (PROSPERO ID: CRD42024612438). The electronic databases PubMed, Embase, Cochrane Library, and Scopus were searched. Effect sizes were estimated using a random-effects model, and trial sequential analysis (TSA) was performed to assess the robustness of the evidence.

Six studies involving a total of 466 patients were included. No significant differences were observed between ESP and QLB in postoperative pain scores measured by the Numeric Rating Scale at 12 hours [mean difference (MD): 0.10; 95% confidence interval (CI): -0.14, 0.35; P = 0.40] and 24 hours (MD: -0.34; 95% CI: -0.74, 0.07; P = 0.10). The time to the first analgesic request was significantly longer in the QLB group (MD: 1.40 hours; 95% CI: 0.42, 2.38; P = 0.005). Opioid consumption within the first 24 hours was comparable between the two techniques (P = 0.93), as was the incidence of nausea and vomiting (P = 0.50). TSA did not confirm firm evidence for differences in opioid consumption, pain intensity at 24 hours, or time to first rescue analgesia, and the results remained inconclusive.

ESP and QLB provide comparable analgesia, though current evidence remains inconclusive. Larger multicentre trials are warranted to confirm these findings.