The analgesic effects of novel fascial plane blocks compared with intrathecal morphine after Caesarean delivery: a systematic review and meta-analysis
Pooled result · Rest pain at 6 h (VAS)Result — go to the resultMD 1.21 cm 95% CI 0.42–2.00Authors' conclusion
Quadratus lumborum block, rather than erector spinae or transversus abdominus plane blocks, may be a better intrathecal morphine alternative owing to similar post-Caesarean analgesic effects and reduced opioid-related side-effects.
Study context
- Population
- Caesarean delivery
- Participants
- 1,525 participants · 18 trials
- Comparison
- Fascial plane blocks vs intrathecal morphine after Caesarean delivery
- Outcome
- Rest pain intensity on VAS 0–10 cm (10 cm = severe pain)
- Follow-up
- 6 h
Methodological detailsHartung-Knapp-Sidik-Jonkman random-effects, Grading of Recommendation, Assessment, Development and Evaluation (GRADE)
- Hartung-Knapp-Sidik-Jonkman random-effects
- GRADE
Pooled result
Rest pain at 6 h (VAS)
MD
1.21 cm
95% CI 0.42–2.00
P = 0.01
Intrathecal morphine vs TAP block
MD 1.21 cm (95% CI 0.42–2.00); P = 0.01
As reported in the abstract
Further pooled results
| Outcome | MD (cm) (95% CI) | P value | |
|---|---|---|---|
| Rest pain at 12 h (VAS)Intrathecal morphine vs TAP block · I2=86%; HKSJ CI; intrathecal morphine superior | 1.03 (0.05–2.01) | P = 0.04 | |
| −10123Difference, cm (linear scale) |
Rest pain at 12 h (visual analogue scale (VAS))
- No differences in pain at 12 h between quadratus lumborum (QL) or erector spinae plane (ESP) block and intrathecal morphine
Other secondary outcomes
- No differences in other outcomes
- GRADE certainty of evidence low across pooled outcomes
Safety
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Nausea and vomitingTAP block vs Intrathecal morphine | 0.41 (0.21–0.79) | P = 0.01 | |
| Nausea and vomitingQL block vs Intrathecal morphine | 0.33 (0.23–0.48) | P = 0.002 | |
| 0.20.5125Odds ratio (log scale) |
Original publication
The analgesic effects of novel fascial plane blocks compared with intrathecal morphine after Caesarean delivery: a systematic review and meta-analysis. Br J Anaesth. Published 11 March 2025. doi:10.
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