An interventional study of Ultrasound-guided Quadratus Lumborum Block, Longitudinal Subcostal Approach and Ultrasound-guided Quadratus Lumborum Block, Anterior Approach in Cesarean Section, sponsored by Universitas Indonesia. Completed at 1 site in Indonesia. Open to female participants aged 18 Years to 45 Years. Per ClinicalTrials.gov, last updated 2026-11-05.
Sponsored by Universitas Indonesia · Not applicable, Interventional, and Treatment
**Brief Summary**
This assessor-blinded randomized clinical trial compared the analgesic effectiveness of longitudinal subcostal (QL-LS) and anterior (QL-A) quadratus lumborum blocks following cesarean section. Both approaches provided comparable pain control at rest and during movement. The QL-LS group demonstrated a significantly longer time to first rescue analgesia than the QL-A group (419.5 vs. 295.5 minutes; p \< 0.001), without a significant difference in 24-hour fentanyl consumption. Block performance times and adverse event profiles were similar. The prolonged initial analgesia with QL-LS may be associated with its more cranial injection site and potential differences in local anesthetic spread. These findings suggest that QL-LS prolongs the time to first rescue analgesia but does not demonstrate superiority in pain intensity reduction or overall opioid consumption.
Background: Post-cesarean pain is complex because it involves both somatic and visceral components and may interfere with early mobilization and recovery. The quadratus lumborum (QL) block is a fascial plane block that has the potential to provide both somatic and visceral analgesia after cesarean section. The anterior and longitudinal subcostal QL approaches differ in the site of local anesthetic deposition and pattern of spread, with the longitudinal subcostal approach targeting a more cranial fascial plane. Clinical evidence directly comparing the analgesic effectiveness of these two approaches in patients undergoing cesarean section remains limited.
Methods: This assessor-blinded randomized clinical trial included patients undergoing Cesarean section under spinal anesthesia. Subjects were allocated into two groups: the QL-LS group, which received a longitudinal subcostal quadratus lumborum block and the QL-A group, which received an anterior quadratus lumborum block. Both blocks were performed bilaterally under ultrasound guidance using 20 mL of 0.25% bupivacaine with 5 mg dexamethasone per side. Outcomes included pain intensity, time to first rescue analgesia, fentanyl consumption via patient-controlled analgesia (PCA), block performance timea and adverse events.
Results: Pain intensity at rest and during movement did not differ significantly between the QL-LS and QL-A groups at any assessment time point. Time to first rescue analgesia was longer in the QL-LS group than in the QL-A group (419.5 vs 295.5 minutes; p\<0.001), whereas 24-hour fentanyl consumption did not differ significantly. Block performance time per side was descriptively similar between the two approaches. The incidence of nausea and vomiting was the same in both groups, while hypotension, lower-extremity motor weakness, and local anesthetic systemic toxicity (LAST) were not observed during the monitoring period.
Discussion: The longitudinal subcostal QL block provided a longer duration of initial analgesia than the anterior QL block, possibly because of its more cranial site of local anesthetic deposition and the potential spread toward the lower thoracic segments and paravertebral structures. This longer duration was not accompanied by differences in pain intensity or 24-hour fentanyl consumption.
Conclusion: The longitudinal subcostal QL block was not superior to the anterior approach in reducing pain intensity or 24-hour fentanyl requirement, but it provided a longer duration of initial analgesia.
Keywords: quadratus lumborum block, longitudinal subcostal approach, anterior approach, cesarean section, postoperative pain.
5,640 studies on the registry are indexed under Pain, Postoperative; 1,230 are open to participants now.
This study's enrollment of 44 is below the median of 75 across 4,821 interventional studies indexed under Pain, Postoperative.
Browse Pain, Postoperative studies →Universitas Indonesia is the lead sponsor of 35 studies on the registry; 13 are open to participants now.
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Exclusion Criteria:
Withdrawal Criteria
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
The anaesthetists’ scale of health before surgery: I is healthy, II has a mild illness that is under control, III a severe one, IV a severe illness that is a constant threat to life. V and VI are used for the critically ill and for organ donors.
Weight in kilograms divided by height in metres squared. Example: 70 kg and 1.75 m gives 70 ÷ (1.75 × 1.75) ≈ 22.9.
What counts as overweight or obesity differs between countries (some use lower cut-offs), so go by the range the study states.
ASA physical status
The anaesthetists’ scale of health before surgery: I is healthy, II has a mild illness that is under control, III a severe one, IV a severe illness that is a constant threat to life. V and VI are used for the critically ill and for organ donors.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
BMI (body mass index)
Weight in kilograms divided by height in metres squared. Example: 70 kg and 1.75 m gives 70 ÷ (1.75 × 1.75) ≈ 22.9.
What counts as overweight or obesity differs between countries (some use lower cut-offs), so go by the range the study states.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Ultrasound-guided bilateral quadratus lumborum block using the anterior approach, with bupivacain 0,25% + dexamethasone 5 mg total volume 20 mL per side, performed after cesarean section for postoperative analgesia.
Procedure: Ultrasound-guided Quadratus Lumborum Block, Anterior Approach · Drug: Bupivacaine 0.25% + Dexamethasone 5 mg
Ultrasound-guided bilateral quadratus lumborum block using the longitudinal subcostal approach, with bupivacain 0,25% + dexamethasone 5 mg total volume 20 mL per side, performed after cesarean section for postoperative analgesia.
Procedure: Ultrasound-guided Quadratus Lumborum Block, Longitudinal Subcostal Approach · Drug: Bupivacaine 0.25% + Dexamethasone 5 mg
Patient in lateral decubitus position. Curvilinear transducer placed in parasagittal orientation in the posterior subcostal region, 6-8 cm lateral to the spinous process, at the QL insertion on the 12th rib. 21G 100 mm needle inserted in-plane caudal to cranial, through latissimus dorsi and QL, to the plane between QL and the anterior thoracolumbar fascia. Performed bilaterally after cesarean section
Patient in lateral decubitus position. Curvilinear transducer placed in transverse orientation at the lumbar triangle (Petit's triangle), moved posteromedially to obtain the shamrock sign at L4. 21G 100 mm needle inserted in-plane posterior to anterior, through QL, to the interfascial plane between QL and psoas major. Performed bilaterally after cesarean section
Bupivacaine 0.25% with dexamethasone 5 mg, total volume 20 mL per side, injected in fractionated doses with intermittent aspiration every 3-5 mL. Same drug, dose and volume in both arms
Post-operative Pain Intensity
Numerical Rating Scale (NRS), scored from 0-10, at 6, 12 and 24 hours after the block
Time frame: From the completion of the block to the 24 hours post-block
Time to first rescue analgesia
Time from the completion of the block to the administration of the first additional analgesia, measured in minutes.
Time frame: From the completion of the block to the 24 hours post-block
Total additional fentanyl consumption
Total fentanyl consumpion measured in microgram, recorded from the patient-controlled analgesia (PCA) device
Time frame: From the completion of the block to the 24 hours post-block
Plan to share: No
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Universitas Indonesia