{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T22:10:43Z","timestamp":1790892643286,"version":"4.1.0"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,3,28]],"date-time":"2021-03-28T00:00:00Z","timestamp":1616889600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Severe postoperative pain is a significant problem after cesarean sections. Methods: This study was a randomized, controlled trial of 105 patients conducted in two hospitals. All patients were anesthetized spinally for elective cesarean section. Each participant was randomly allocated to one of three study groups: the quadratus lumborum block (QLB) group, the transversus abdominis plane block (TAPB) group, or the control (CON) group. The primary outcome of this study determined acute pain intensity on the visual analog scale (VAS). The secondary outcomes determined morphine consumption and chronic pain evaluation according to the Neuropathic Pain Symptom Inventory (NPSI) after hospital discharge. Results: At rest, the pain intensity was significantly higher in the CON group than in the QLB and TAPB groups at hours two and eight. Upon activity, the pain in the control subjects was more severe than in the QLB and TAPB groups in three and two of five measurements, respectively. Moreover, morphine consumption was significantly lower in the QLB (9 (5\u201310)) and TAPB (10 (6\u201314)) groups than in the CON (16 (11\u201319)) group. Persistent postoperative pain was significantly lower in the QLB group than in the CON group at months one and six following hospital discharge. Conclusions: Both the QLB and TAPB can improve pain management after cesarean delivery. Moreover, the QLB might reduce the severity of persistent postoperative pain months after cesarean section.<\/jats:p>","DOI":"10.3390\/ijerph18073500","type":"journal-article","created":{"date-parts":[[2021,3,28]],"date-time":"2021-03-28T22:09:01Z","timestamp":1616969341000},"page":"3500","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Quadratus Lumborum and Transversus Abdominis Plane Blocks and Their Impact on Acute and Chronic Pain in Patients after Cesarean Section: A Randomized Controlled Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6183-811X","authenticated-orcid":false,"given":"Micha\u0142","family":"Borys","sequence":"first","affiliation":[{"name":"Second Department of Anesthesia and Intensive Care, Medical University of Lublin, 20-059 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Zamaro","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Perinatology, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beata","family":"Horeczy","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Department with the Center for Acute Poisoning, St. Jadwiga Provincial Clinical Hospital, 35-301 Rzesz\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"G\u0119szka","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Perinatology, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5492-2594","authenticated-orcid":false,"given":"Marek","family":"Janiak","sequence":"additional","affiliation":[{"name":"First Department of Anesthesiology and Intensive Care, Medical University of Warsaw, 02-091 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9876-8493","authenticated-orcid":false,"given":"Piotr","family":"W\u0119grzyn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Perinatology, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miros\u0142aw","family":"Czuczwar","sequence":"additional","affiliation":[{"name":"Second Department of Anesthesia and Intensive Care, Medical University of Lublin, 20-059 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawe\u0142","family":"Piwowarczyk","sequence":"additional","affiliation":[{"name":"Second Department of Anesthesia and Intensive Care, Medical University of Lublin, 20-059 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Betr\u00e1n, A., Ye, J., Moller, A., Zhang, J., G\u00fclmezoglu, A., and Torloni, M. (2016). The increasing trend in Caesarean section rates: Global, regional and national estimates: 1990\u20132014. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0148343"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1093\/bmb\/ldr050","article-title":"Overview of anesthetic considerations for Cesarean delivery","volume":"101","author":"Rollins","year":"2012","journal-title":"Br. Med. Bull."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Borys, M., Zyzak, K., Hanych, A., Domaga\u0142a, M., Ga\u0142kin, P., Ga\u0142aszkiewicz, K., K\u0142aput, A., Wr\u00f3blewski, K., Mi\u0119kina, J., and Onichimowski, D. (2018). Survey of postoperative pain control in different types of hospitals: A multicenter observational study. BMC Anesthesiol., 18.","DOI":"10.1186\/s12871-018-0551-3"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.pain.2008.07.011","article-title":"Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression","volume":"140","author":"Eisenach","year":"2008","journal-title":"Pain"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1111\/j.1440-1754.2007.01057.x","article-title":"Psychosocial adjustment and physical health of children living with maternal chronic pain","volume":"43","author":"Evans","year":"2007","journal-title":"J. Paediatr. Child Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1097\/AAP.0000000000000545","article-title":"Essentials of our current understanding: Abdominal wall blocks","volume":"42","author":"Chin","year":"2019","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Mitchell, K., Smith, C., Mechling, C., Wessel, C., Orebaugh, S., and Lim, G. (2019). A review of peripheral nerve blocks for cesarean delivery analgesia. Reg. Anesth. Pain Med.","DOI":"10.1136\/rapm-2019-100752"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1093\/bja\/aes279","article-title":"Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis","volume":"109","author":"Abdallah","year":"2012","journal-title":"Br. J. Anaesth."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ijoa.2016.07.009","article-title":"Clinical effectiveness of transversus abdominis plane (TAP) blocks for pain relief after caesarean section: A meta-analysis","volume":"28","author":"Champaneria","year":"2016","journal-title":"Int. J. Obstet. Anesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1097\/EJA.0000000000000299","article-title":"Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial","volume":"32","author":"Blanco","year":"2015","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"89","DOI":"10.5603\/GP.a2018.0015","article-title":"Evaluation of the effectiveness of the Quadratus Lumborum Block type I using ropivacaine in postoperative analgesia after a cesarean section: A controlled clinical study","volume":"89","author":"Mieszkowski","year":"2018","journal-title":"Ginekol. Pol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1111\/anae.14852","article-title":"Quadratus lumborum block for analgesia after caesarean section: A randomised controlled trial","volume":"75","author":"Irwin","year":"2020","journal-title":"Anaesthesia"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1213\/ANE.0000000000002648","article-title":"The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery: A randomized clinical trial","volume":"126","author":"Krohg","year":"2018","journal-title":"Anesth. Analg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Hansen, C., Dam, M., Steingrimsdottir, G., Laier, G., Lebech, M., Poulsen, T., Chan, V., Wolmarans, M., Bendtsen, T., and B\u00f8rglum, J. (2019). Ultrasound-guided transmuscular quadratus lumborum block for elective cesarean section significantly reduces postoperative opioid consumption and prolongs time to first opioid request: A double-blind randomized trial [published online first, 2019 Jul 14). Reg. Anesth. Pain Med.","DOI":"10.1136\/rapm-2019-100540"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1097\/AAP.0000000000000495","article-title":"Quadratus lumborum block versus transversus abdominis plane block for postoperative pain after cesarean delivery: A randomized controlled trial","volume":"41","author":"Blanco","year":"2016","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.pain.2003.12.024","article-title":"Development and validation of the Neuropathic Pain Symptom Inventory","volume":"108","author":"Bouhassira","year":"2004","journal-title":"Pain"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"257","DOI":"10.5114\/ait.2019.88071","article-title":"Transversus abdominis plane block and quadratus lumborum block did not reduce the incidence or severity of chronic postsurgical pain following cesarean section: A prospective, observational study","volume":"51","author":"Borys","year":"2019","journal-title":"Anaesthesiol. Intensive Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1097\/j.pain.0000000000001413","article-title":"IASP Taskforce for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: Chronic postsurgical or posttraumatic pain","volume":"160","author":"Schug","year":"2019","journal-title":"Pain"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1111\/anae.15068","article-title":"Quadratus lumborum block vs. transversus abdominis plane block for caesarean delivery: A systematic review and network meta-analysis","volume":"76","author":"Desai","year":"2021","journal-title":"Anaesthesia"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1213\/01.ane.0000230603.92574.4e","article-title":"Preincisional paravertebral block reduces the prevalence of chronic pain after breast surgery","volume":"103","author":"Kairaluoma","year":"2006","journal-title":"Anesth. Analg."},{"key":"ref_21","first-page":"206","article-title":"Correlation of acute pain treatment to occurrence of chronic pain in tumor patients after thoracotomy","volume":"27","author":"Lu","year":"2008","journal-title":"Aizheng"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Borys, M., Hanych, A., and Czuczwar, M. (2020). Paravertebral block versus preemptive ketamine effect on pain intensity after posterolateral thoracotomies: A randomized controlled trial. J. Clin. Med., 9.","DOI":"10.20944\/preprints202002.0093.v1"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/AJP.0b013e3181b99ddd","article-title":"Intraperitoneal lidocaine instillation and postcesarean pain after parietal peritoneal closure: A randomized double-blind placebo-controlled trial","volume":"26","author":"Shahin","year":"2010","journal-title":"Clin. J. Pain"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1097\/AJP.0000000000000005","article-title":"Perioperative epidural or intravenous ketamine does not improve the effectiveness of thoracic epidural analgesia for acute and chronic pain after thoracotomy","volume":"30","author":"Tena","year":"2014","journal-title":"Clin. J. Pain"},{"key":"ref_25","first-page":"757","article-title":"S+ -ketamine for control of perioperative pain and prevention of post thoracotomy pain syndrome: A randomized, double-blind study","volume":"78","author":"Mendola","year":"2012","journal-title":"Minerva Anestesiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"239","DOI":"10.3344\/kjp.2016.29.4.239","article-title":"Chronic persistent post-surgical pain following staging laparotomy for carcinoma of ovary and its relationship to signal transduction genes","volume":"29","author":"Saxena","year":"2016","journal-title":"Korean J. Pain"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1080\/01443615.2018.1437125","article-title":"Postoperative pain and neuropathy after caesarean operation featuring blunt or sharp opening of the fascia: A randomised, parallel group, double-blind study","volume":"38","author":"Yildiz","year":"2018","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1111\/aogs.12613","article-title":"Risk factors for persistent pain and its influence on maternal wellbeing after cesarean section","volume":"94","author":"Niklasson","year":"2015","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ijoa.2018.01.009","article-title":"Incidence and risk factors for chronic pain after elective caesarean delivery under spinal anaesthesia in a Chinese cohort: A prospective study","volume":"34","author":"Wang","year":"2018","journal-title":"Int. J. Obstet. Anesth."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1007\/s12630-014-0162-5","article-title":"Transversus abdominis plane block does not improve early or late pain outcomes after Cesarean delivery: A randomized controlled trial","volume":"61","author":"McKeen","year":"2014","journal-title":"Can. J. Anaesth."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/7\/3500\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:33:00Z","timestamp":1760362380000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/7\/3500"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,28]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["ijerph18073500"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18073500","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,28]]}}}