Optimal approach to ultrasound-guided quadratus lumborum blocks for postoperative analgesia in elective caesarean section: protocol for systematic review and meta-analysis

Abstract

Introduction: Ultrasound-guided quadratus lumborum blocks are commonly used for postoperative analgesia during caesarean section. Ultrasound-guided quadratus lumborum blocks can be performed through four approaches, including lateral, posterior, anterior, and intramuscular quadratus lumborum blocks. This systematic review and meta-analysis aims to determine the optimal approach to ultrasound-guided quadratus lumborum blocks for postoperative analgesia in elective caesarean section.

Methods and analysis: The PubMed, EMBASE, Cochrane Library and Web of Science databases will be systematically searched from their inception to 30 July 2024. Randomised controlled trials that compared the analgesic effects of different ultrasound-guided quadratus lumborum block approaches in elective caesarean section will be included. Only publications in English will be eligible for inclusion. The total postoperative analgesic consumption over 24 hours will be the primary outcome. The time to first analgesic request, postoperative pain scores at rest and during movement, and incidence of adverse effects will be secondary outcomes. RevMan V.5.4 will be used for the statistical analysis. Network meta-analysis will be used for indirect comparisons between different approaches across studies. The Grading of Recommendations Assessment, Development and Evaluation approach will be used to assess the quality of evidence for each outcome.

Ethics and dissemination: Ethical approval was not required. The results of this study will be submitted to peer-reviewed journals.

Prospero registration number: CRD42024503694.

Keywords: Adult anaesthesia; Anaesthesia in obstetrics; Pain management.

Figure 1. Flow chart for study selection.