A COMPARATIVE STUDY OF EFFICACY OF USG-GUIDED B/L QUADRATUS LUMBORUM BLOCK VERSUS ILIOINGUINAL ILIOHYPOGASTRIC BLOCK FOR POSTOPERATIVE ANALGESIA IN ELECTIVE CAESAREAN SECTION SURGERIES

Abstract

Background: Effective postoperative pain management after caesarean section supports early ambulation, breastfeeding and early discharge, and is a key component of enhanced recovery. The ultrasound-guided quadratus lumborum (QL) block provides both visceral and somatic analgesia for lower abdominal surgery, whereas the ilioinguinal–iliohypogastric (ILIH) block provides somatic analgesia without a visceral component. Both blocks have been studied individually, but direct comparisons in caesarean section are limited.

Objective: To compare the analgesic efficacy of ultrasound-guided bilateral QL block versus bilateral ILIH block for postoperative analgesia in parturients undergoing elective caesarean section, assessed by visual analogue scale (VAS) scores, dynamic VAS scores, time to first rescue analgesia and number of rescue doses in the first 24 hours.

Methods: In this randomized controlled trial, 100 parturients (ASA grade II–III, aged 18–40 years) undergoing elective caesarean section were randomized to Group Q (bilateral QL block; 0.375% ropivacaine with 8 mg dexamethasone, 25 mL each side; n=50) or Group I (bilateral ILIH block; 0.375% ropivacaine with 8 mg dexamethasone, 15 mL each side; n=50). Static and dynamic VAS scores were recorded at 2, 4, 6, 8, 12 and 24 hours, along with time to first rescue analgesia and total rescue doses over 24 hours. Continuous variables were analysed by Student's t-test and proportions by chi-square test using SPSS version 25; p<0.05 was considered significant.

Results: Both groups had comparable static and dynamic VAS scores for the first 12 hours (all p>0.05). At 24 hours, the QL group had significantly lower static VAS (3.40±1.17 vs 4.54±0.774; p=0.01) and dynamic VAS (3.89±1.05 vs 5.45±1.10; p=0.01) than the ILIH group. Time to first rescue analgesia (20.97±4.53 vs 20.80±5.02 hours; p=0.85) and the number of rescue doses in 24 hours (0.95±0.87 vs 1.12±1.08; p=0.38) were comparable between the groups.

Conclusion: Both the ultrasound-guided quadratus lumborum block and the ilioinguinal–iliohypogastric block provided comparable and effective postoperative analgesia for parturients undergoing elective caesarean section. The QL block offered a modest advantage in pain scores at 24 hours, but both blocks were similarly efficacious with respect to rescue analgesic requirement, making the ILIH block a reasonable alternative to the QL block.