Comparison of ultrasound-guided quadratus lumborum block and other regional blocks for postoperative pain in cesarean section: a systematic review and meta-analysis of randomized clinical trials
Abstract
Background: Acute post-cesarean section (C/S) pain causes adverse maternal outcomes, and multimodal opioid-sparing analgesia is central to Enhanced Recovery after Surgery (ERAS) protocols. Quadratus lumborum block (QLB) is a promising regional technique, but evidence comparing it with other regional blocks remains fragmented.
Methods: We conducted a systematic review and meta-analysis of RCTs (PubMed, EMBASE, Web of Science; inception to September 2025). Eligible studies included adults undergoing C/S with QLB. Primary outcome was 24-h cumulative morphine consumption; secondary outcomes included pain scores, recovery metrics, and adverse events. RoB 2 and GRADE assessed study quality and evidence certainty.
Results: Twenty-three RCTs (1,935 patients) were included. QLB reduced 24-h (MD = -3.19; 95% CI, -5.09, -1.30; p = 0.0009) and 48-h (MD = -16.51; 95%CI, -27.64, -5.39; p = 0.004) morphine consumption, and 24-h dynamic pain scores (MD = -0.52; 95% CI, -0.87, -0.17; p = 0.003). No significant differences were observed in resting pain, recovery metrics, satisfaction, or opioid-related adverse events. GRADE certainty for the primary outcome was moderate.
Conclusion: QLB was associated with modest reductions in postoperative opioid consumption and 24-h dynamic pain after C/S; however, the clinical significance is limited (pain reduction below the minimally clinically important difference), and the certainty of evidence is moderate-to-low due to very high heterogeneity (I2 >…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,935 participants or records.
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