Sezaryen hastalarında trunkal blokların kronik postoperatif ağrı üzerine etkisinin değerlendirilmesi: retrospektif kohort çalışması

Year 2025, Volume: 6 Issue: 5, 481 - 486, 24.10.2025

Serpil Şehirlioglu , Veysel Dinç

Abstract

Amaç:
Kronik postoperatif ağrı (CPSP), sezaryen sonrası giderek daha fazla tanınan bir komplikasyondur ve maternal yaşam kalitesi üzerinde olumsuz etkiler yaratabilir. Etkin postoperatif analjezinin CPSP riskini azaltmada rol oynayabileceği öne sürülmektedir. Bu çalışmanın amacı, spinal anestezi altında yapılan sezaryen operasyonları sonrasında multimodal analjezi kapsamında uygulanan fasyal plan bloklarının CPSP insidansı ve karakteristikleri üzerindeki etkisini değerlendirmektir.
Yöntem:
Bu retrospektif, tek merkezli kohort çalışmaya, Ocak 2024 ile Mart 2025 tarihleri arasında spinal anestezi altında elektif sezaryen operasyonu geçiren, 18–40 yaş aralığında ve tekil gebeliğe sahip kadınlar dahil edildi. Hastalar iki gruba ayrıldı: anterior quadratus lumborum bloğu (QLB) veya ilioinguinal–iliohipogastrik (II-IH) sinir bloğu ile multimodal analjezi uygulanan Grup M ve yalnızca standart sistemik analjezi alan Grup S. Veriler, anestezi ve postoperatif analjezi kayıtlarından elde edildi. Hastalar postoperatif üçüncü ayda telefonla aranarak ağrı durumları sorgulandı. CPSP, üçüncü ayın sonunda devam eden ağrı olarak tanımlandı. Yanma, karıncalanma, kaşıntı ve uyuşukluk gibi nöropatik özellikler ayrıca değerlendirildi.
Bulgular:
Toplam 191 hasta çalışmaya dahil edildi: Grup M’de 90, Grup S’de 101 hasta. Grupların demografik özellikleri karşılaştırılabilir düzeydeydi. Üçüncü ayda CPSP insidansı Grup M’de %27,8 ve Grup S’de %28,7 olarak bulundu (p = 0,886). Tüm ağrılar insizyon bölgesinde lokalizeydi ve çoğunlukla hafif ve aralıklıydı. Yanma ve karıncalanma açısından gruplar arasında fark saptanmadı. Ancak kaşıntı (Grup M’de %60, Grup S’de %89,7; p = 0,011) ve uyuşukluk (Grup M’de %36, Grup S’de %72,4; p = 0,007) blok uygulanan grupta anlamlı olarak daha düşük bulundu.
Sonuç:
Sezaryen sonrası üçüncü ayda CPSP insidansı, fasyal plan bloğu uygulanan hastalar ile standart analjezi alan hastalar arasında benzer bulundu. Bununla birlikte, fasyal plan blokları bazı nöropatik semptomların daha az görülmesi ile ilişkiliydi ve postoperatif ağrı yönetiminde niteliksel bir fayda sağlayabileceğini düşündürmektedir.

Keywords

sezaryen , kronik ağrı , multimodal analjezi , cerrahi sonrası kronik ağrı , fasyal plan blokları

The efficacy of ultrasound-guided regional anesthesia on chronic postoperative pain in patients who underwent caesarean section: a retrospective study

Abstract

Aims: Chronic postsurgical pain (CPSP) is an well-recognised complication following caesarean delivery and may adversely affect maternal quality of life. Effective postoperative analgesia has been suggested to reduce the risk of CPSP. This study aimed to evaluate the effect of ultrasound-guided regional blocks, applied as part of multimodal analgesia, on the incidence and characteristics of CPSP after caesarean section under spinal anaesthesia.
Methods: This retrospective, single-center cohort study included women aged 18–40 years with singleton pregnancies who underwent elective caesarean section under spinal anaesthesia between January 2024 and March 2025. Patients were divided into two groups: Group RA (regional anesthesia), who received multimodal analgesia with either anterior quadratus lumborum block or ilioinguinal–iliohypogastric nerve block, and group non-RA, who received standard systemic analgesia alone. Data were obtained from anaesthesia and postoperative analgesia records. Patients were contacted by telephone after completing ≥90 postoperative days to assess their pain status. Neuropathic features such as burning, tingling, itching, and numbness were also evaluated.
Results: A total of 191 patients were included: 90 in group RA and 101 in group non-RA. The demographic characteristics of the two groups were comparable. The incidence of CPSP at three months was 27.8% in group RA and 28.7% in group non-RA (p=0.886). All pain was localised to the incision site and was mostly mild and intermittent. No significant differences were found between the groups for burning (8.9% in group non-RA vs. 8.9% in group RA), tingling (10.9% in group non-RA vs. 7.8% in group RA), and itching (25.7% in group non-RA vs. 16.7% in group RA). However, the rate of numbness was significantly higher in the non-RA group compared to the RA group (20.8% vs. 10.0%, p=0.041).
Conclusion: The incidence of CPSP at ≥3 months after caesarean delivery was similar between patients receiving regional blocks and those treated with standard analgesia. However, regional blocks were associated with a lower frequency of certain neuropathic symptoms, suggesting a potential qualitative benefit in postoperative pain management.

Keywords

Caesarean delivery , multimodal analgesia , chronic pain , chronic postsurgical pain , fascial plane blosks

References

• Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6(6):e005671. doi:10.1136/bmjgh-2021-005671
• Ciechanowicz S, Joy RR, Kasmirski J, Blake L, Carvalho B, Sultan P. Incidence, severity, and interference of chronic postsurgical pain after cesarean delivery: a systematic review and meta-analysis. J Clin Anesth. 2025;104:111832. doi:10.1016/j.jclinane.2025.111832
• Wang LZ, Huang JY, Hu HJ, Xia F. Incidence of chronic postsurgical pain after caesarean delivery: a systematic review and meta-analysis. Anaesthesia. 2025;80(7):834-845. doi:10.1111/anae.16596
• Borges NC, de Deus JM, Guimarães RA, et al. The incidence of chronic pain following cesarean section and associated risk factors: a cohort of women followed up for three months. PLoS One. 2020;15(9):e0238634. doi:10.1371/journal.pone.0238634
• Richez B, Ouchchane L, Guttmann A, et al. The role of psychological factors in persistent pain after cesarean delivery. J Pain. 2015;16(11):1136-1146. doi:10.1016/j.jpain.2015.08.001
• Yetik F, Yilmaz C, Karasu D, Haliloğlu Dastan N, Dayioğlu M, Baytar Ç. Comparison of ultrasound-guided quadratus lumborum block-2 and quadratus lumborum block-3 for postoperative pain in cesarean section: a randomized clinical trial. Medicine (Baltimore). 2022;101(49):e31844. doi:10.1097/MD.0000000000031844
• Tanggaard K, Nielsen MV, Holm UHU, et al. No quadriceps muscle weakness following anterior quadratus lumborum block compared with placebo: a randomized, non-inferiority, blinded, volunteer trial. Reg Anesth Pain Med. 2025;50(7):568-574. doi:10.1136/rapm-2024-105313
• Salama ER. Ultrasound-guided bilateral quadratus lumborum block vs. intrathecal morphine for postoperative analgesia after cesarean section: a randomized controlled trial. Korean J Anesthesiol. 2020;73(2):121-128. doi:10.4097/kja.d.18.00269
• Giral T, Delvaux BV, Huynh D, et al. Posterior quadratus lumborum block versus intrathecal morphine analgesia after scheduled cesarean section: a prospective, randomized, controlled study. Reg Anesth Pain Med. 2024:rapm-2024-105454. doi:10.1136/rapm-2024-105454
• de Brito Cançado TO, Omais M, Ashmawi HA, Torres ML. Chronic pain after cesarean section. Influence of anesthetic/surgical technique and postoperative analgesia. Rev Bras Anestesiol. 2012;62(6):762-774. doi:10.1016/S0034-7094(12)70177-0
• Bollag L, Lim G, Sultan P, et al. Society for obstetric anesthesia and perinatology: consensus statement and recommendations for enhanced recovery after cesarean. Anesth Analg. 2021;132:1362-1377. doi:10.1213/ANE.0000000000005257
• Roofthooft E, Joshi GP, Rawal N, et al. PROSPECT Working Group* of the European Society of Regional Anaesthesia and Pain Therapy and supported by the Obstetric Anaesthetists’ Association. PROSPECT guideline for elective caesarean section: updated systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2021;76(5):665-680. doi:10.1111/anae.15339
• Roofthooft E, Joshi GP, Rawal N, et al. PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy. PROSPECT guideline for elective caesarean section: an update. Anaesthesia. 2023;78(9):1170-1171. doi:10.1111/anae.16034
• Blanco R, Ansari T, Girgis E. Sezaryen sonrası postoperatif ağrı için Quadratus lumborum bloğu: randomize kontrollü bir çalışma. Eur J Anaesthesiol. 2015;32:812-818.
• Børglum J, Moriggl B, Jensen K, et al. Ultrasound-guided transmuscular quadratus lumborum blockade. Br J Anaesth. 2013;111:3. doi:10.1093/bja/el_9919
• Elsharkawy H, El-Boghdadly K, Barrington M. Quadratus lumborum block: anatomical concepts, mechanisms, and techniques. Anesthesiology. 2019;130(2):322-335. doi:10.1097/ALN.0000000000002524
• Bessmertnyj AE, Antipin EE, Uvarov DN, Sedyh SV, Nedashkovsky EV. Comparison of the effectiveness of ilioinguinal-iliohypogastric blockade and transversus abdominis plane block for analgesia after cesarean section. Anesteziol Reanimatol. 2015;60(2):51-54.
• Jin Y, Li Y, Zhu S, Zhu G, Yu M. Comparison of ultrasound-guided iliohypogastric/ilioinguinal nerve block and transversus abdominis plane block for analgesia after cesarean section: a retrospective propensity match study. Exp Ther Med. 2019;18(1):289-295. doi:10.3892/etm.2019.7540
• Rodríguez Roca MC, Brogly N, Gredilla Diaz E, et al. Neuropathic component of postoperative pain for predicting post-cesarean chronic pain at three months: a prospective observational study. Minerva Anestesiol. 2021;87(12):1290-1299. doi:10.23736/S0375-9393.21.15654-8
• Niklasson B, Georgsson Öhman S, Segerdahl M, Blanck A. Risk factors for persistent pain and its influence on maternal wellbeing after cesarean section. Acta Obstet Gynecol Scand. 2015;94(6):622-628. doi:10.1111/aogs.12613
• Öksüz G, Bilal B, Gürkan Y, et al. Quadratus lumborum block versus transversus abdominis plane block in children undergoing low abdominal surgery: a randomized controlled trial. Reg Anesth Pain Med. 2017;42(5):674-679. doi:10.1097/AAP.0000000000000645
• Şehirlioğlu S, Moralar DG, Ozakin O, Aydemir T, Ergul F. Anterior quadratus lumborum block versus modified perichondrial thoracoabdominal nerve block (m-TAPA) for postoperative analgesia following laparoscopic cholecystectomy: a randomized controlled trial. BMC Anesthesiol. 2025;25(1):393. doi:10.1186/s12871-025-03281-x