Opioid-Free Cesarean Section with Bilateral Quadratus Lumborum Catheters
Authors Hernandez N, Ghebremichael SJ, Sen S, de Haan JB
Received 10 November 2019
Accepted for publication 23 January 2020
Published 7 February 2020 Volume 2020:13 Pages 17—20
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Stefan Wirz
Nadia Hernandez, Semhar J Ghebremichael, Sudipta Sen, Johanna B de Haan
Department of Anesthesiology, University of Texas Health Science Center at Houston, Houston, TX, USA
Correspondence: Johanna B de Haan
Department of Anesthesiology, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.020, Houston, TX 77030, USA
Tel +1 713-500-6200
Fax +1 713-500-0528
Introduction: Post-operative pain control following cesarean section delivery (CD) is an important topic of discussion given the lack of consensus on a narcotic-sparing analgesic regimen. We describe the case of an elective CD with narcotic-free pain control using continuous bilateral posterior quadratus lumborum (QL) blockade as the primary mode of analgesia.
Case Report: The patient is a 36-year-old female, G3P1, who presented at 37 weeks of gestation in active labor scheduled for elective primary CD. A spinal anesthetic was performed at L4–L5 with hyperbaric 0.75% bupivacaine, without intrathecal morphine. Bilateral posterior QL catheters were placed under sterile conditions with 20 mL of 0.25% bupivacaine per side. Continuous infusion of 0.2% ropivacaine was then started at 10 mL/hour per side. The patient’s pain was controlled with QL catheters and a multimodal pain regimen consisting of non-steroidal anti-inflammatory drugs and acetaminophen. The patient reported a resting pain score of 0 with a dynamic pain score of 3 out of 10 throughout her recovery. She was discharged on post-operative (post-op) day 3 and the catheters were removed without any complications.
Discussion: The gold standard for pain control following CD is intrathecal morphine; however, its use has many adverse effects. Bilateral single-shot QL blocks following CD have been proven to decrease opioid consumption but its limited duration has minimal advantage over intrathecal morphine and patients continue to require oral narcotics for analgesia. With the use of QL catheters and a multimodal pain regimen, it may be possible to achieve opioid-free CD for the post-op period.
Keywords: obstetric anesthesia, pain management, quadratus lumborum, peripheral nerve block, peripheral nerve block catheters, cesarean section, cesarean section recovery
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