Regional methods of anesthesia in labor pain relief: a systematic review
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obstetric anesthesia
nerve block
pudendal blockade
systematic review

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Makcharin OA, Lebedeva EA, Kochubeinik NV Regional methods of anesthesia in labor pain relief: a systematic review. Annals of Critical Care. 2022;(4):55–65. doi:10.21320/1818-474X-2022-4-55-65.


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INTRODUCTION: Today epidural anesthesia is the “golden standard” of anesthesia. But what can we do if the application of an epidural catheter is contraindicated? The use of narcotic analgesics can hardly be deemed a worthy alternative. OBJECTIVE: To identify alternative regional methods of anesthesia in labour pain relief. MATERIALS AND METHODS: We have performed a systematic review of literature in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guideline principles. The bibliographic search was conducted in January-March 2022. The search was performed in the MEDLINE, EMBASE,, Cochrane Library databases. The search keywords were: anesthesia of childbirth, pudendal block, paracervical block, paravertebral block, quadratic lumbar muscle (QLB) block, erector spinae plane block (ESPB). We found 122 works, and after removing 94 works for various reasons, 28 works were analyzed. RESULTS: We found 122 works, and after removing 94 works for various reasons, 28 works were analyzed. We identified six randomized controlled trials related to the subject matter, but the endpoints were heterogeneous preventing a statistical analysis; therefore, we performed a qualitative review of the literature. Works dedicated to paravertebral and paracervial blocks showed sufficient effectiveness of anesthesia for the second period of labor. Good results of anesthesia of the second period of labor were also described with the use of ESPB and bilateral QLB. Nevertheless, it is impossible to draw statistically significant conclusions on the use of ESPB and QLB due to the small sample. Articles devoted to the use of pudendal block in labour revealed its low effectiveness. CONCLUSIONS: The described results show that paravertebral, ESPB and QLB blocks can be used as alternative regional methods of anesthesia in labour. However, further research is required to assess the effectiveness of their use in childbirth.
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  1. Куликов А.В., Шифман Е.М. Анестезия, интенсивная терапия и реанимация в акушерстве и гинекологии. Клинические рекомендации. Протоколы лечения. Изд. 2-е, доп. и перераб. М.: Медицина, 2017. 153–68. [Kulikov A.V., Shifman E.M. Anesthesia, intensive care and reanimatology in obstetrics and gynecology. Clinical recommendations. Treatment protocols. The second edition, supplemented and revised. M.: Medicine, 2017. P. 153–68. (In Russ)]
  2. Liberati A., Altman D.G., Tetzlaff J., et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. JClin Epidemiol. 2009; 62(10): 1–34. DOI: 10.1016/j.jclinepi.2009.06.006
  3. Shravage J., Sinha R. A one year randomised clinical trial to study the effect of paracervical block in accelerating the active phase of labour in primigravidas. J Obstet Gynecol India. 2001; 51: 71–3.
  4. Nikkola E., Jahnukainen T., Eklad U., et al. Neonatal monitoring after maternal fentanyl analgesia in labor. Journal of Clinical Monitoring and Computing. 2000; 16: 597–608. DOI: 10.1023/a:1012268617009
  5. Jensen F., Qvist I., Brocks V., et al. Submucous paracervical blockade compared with intramuscular meperidine as analgesia during labor: a doubleblind study. Obstet Gynecol. 1984; 64: 724–7.
  6. Novikova N., Cluver C. Local anaesthetic nerve block for pain management in labour. Cochrane Database of Systematic Reviews. 2012. DOI: 10.1002/14651858.CD009200.pub2
  7. Bendtsen T., Parras T., Moriggl B., et al. Ultrasound-guided pudendal nerve block at the entrance of the pudendal (Alcock) canal: description of anatomy and clinical technique. Reg Anesth Pain Med. 2016; 41: 140–5. DOI: 10.1097/AAP.0000000000000355
  8. Soucy B., Luong D., Michaud J., et al. Accuracy of ultrasound guided pudendal nerve block in the ischial spine and Alcock’s canal levels: a cadaveric study. Pain Med. 2020; 21: 2692–8. DOI: 10.1093/pm/pnaa136
  9. Hutchins C. Spinal analgesia for instrumental delivery. A comparison with pudendal nerve block. Anaesthesia. 1980; 35: 376–7.
  10. Nikpoor P., Bain E. Analgesia for forceps delivery. Cochrane Database of Systematic Reviews. 2013. DOI: 10.1002/14651858.CD008878.pub2
  11. Антипин Э.Э., Уваров Д.Н., Недашковский Э.В., Кушев И.П. Эпидуральная анальгезия в первом периоде родов — есть ли альтернатива? Анестезиология иреаниматология. 2014; 1: 18–22. [Antipin E.E., Uvarov D.N., Nedashkovsky E.V., Kushev I.P. Epidural analgesia in the first stage of labor — is there an alternative? Anesteziologiya i Reanimatologyia. 2014; 1: 18–22 (In Russ)]
  12. Неймарк М.И., Иванова О.С. Обоснование целесообразности паравертебральной блокады для анальгезии самопроизвольных родов. Вестник анестезиологии иреаниматологии. 2018; 15(3): 26–33. DOI: 10.21292/2078-5658-2018-15-3-26-33 [Neymark M.I., Ivanova O.S. Rationale for paravertebral block for analgesia in spontaneous labor. Messenger of Anesthesiology and Resuscitation. 2018; 15(3): 26–33. DOI: 10.21292/2078-5658-2018-15-3-26-33 (In Russ)]
  13. Eason M.J., Wyatt R. Paravertebral thoracic block—A reappraisal. Anaesthesia. 1979; 34: 638–42. DOI: 10.1111/j.1365-2044.1979.tb06363.x
  14. Shaw W.M. Medial approach for paravertebral somatic nerve block. JAm Med Assoc. 1952; 148: 742–4.
  15. Richardson J., Cheema S.P., Hawkins J., et al. Thoracic paravertebral space location. A new method using pressure measurement. Anaesthesia. 1996; 51: 137–9. DOI: 10.1111/j.1365-2044.1996.tb07700.x
  16. Tenicela R., Pollan S.B. Paravertebral-peridural block technique: A unilateral thoracic block. Clin J Pain. 1990; 6: 227–34. DOI: 10.1097/00002508-199009000-00010
  17. Lang S.A. The use of a nerve stimulator for thoracic paravertebral block. Anesthesiology. 2002; 97: 521–2. DOI: 10.1097/00000542-200208000-00037
  18. Coveney E., Weltz C.R., Greengrass R., et al. Use of paravertebral block anesthesia in the surgical management of breast cancer: Experience in 156 cases. Ann Surg. 1998; 227: 496–501. DOI: 10.1097/00000658-199804000-00008
  19. Lang S.A., Saito T. Thoracic paravertebral nerve block, nerve stimulator guidance and the endothoracic fascia. Anaesthesia. 2005; 60: 930–1. DOI: 10.1111/j.1365-2044.2005.04340.x
  20. Shibata Y., Nishiwaki K. Ultrasound-guided intercostal approach to thoracic paravertebral block. Anesth Analg. 2009; 109: 996–7. DOI: 10.1213/ane.0b013e3181af7e7b
  21. Lichtenstein D., Meziere G., Biderman P., et al. The comet-tail artifact: An ultrasound sign ruling out pneumothorax. Intensive Care Med. 1999; 25: 383–8; DOI: 10.1007/s001340050862
  22. Luyet C., Eichenberger U., Greif R., et al. Ultrasound-guided paravertebral puncture and placement of catheters in human cadavers: an imaging study. Br J Anaesth. 2009; 102: 534–9. DOI: 10.1093/bja/aep015
  23. Cowie B., McGlade D., Ivanusic J., et al. Ultrasoundguided thoracic paravertebral blockade: a cadaveric study. Anesthesia and Analgesia. 2010; 110: 1735–9. DOI: 10.1213/ANE.0b013e3181dd58b0
  24. Uppal V., Sondekoppam R., Sodhi P., et al. Single-injection versus multiple-injection technique of ultrasound-guided paravertebral blocks: a randomized controlled study comparing dermatomal spread. Reg Anesth Pain Med. 2017; 42: 575–81. DOI: 10.1097/AAP.0000000000000631
  25. Luyet C., Siegenthaler A., Szucs-Farkas Z., et al. The location of paravertebral catheters placed using the landmark technique. Anaesthesia. 2012; 67: 1321–6. DOI: 10.1111/j.1365-2044.2012.07234.x
  26. Renes S.H., Bruhn J., Gielen M., et al. In-Plane ultrasound-guided thoracic paravertebral block: a preliminary report of 36 cases with radiologic confirmation of catheter position. Reg Anesth Pain Med. 2010; 35: 212–16. DOI: 10.1097/aap.0b013e3181c75a8b
  27. Forero M., Adhikary S.D., Lopez H., et al. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016; 41: 621–7. DOI: 10.1097/AAP.0000000000000451
  28. Abu Elyazed M.M., Mostafa S.F., Abdelghany M.S., et al. Ultrasound-guided erector spinae plane block in patients undergoing open epigastric hernia repair: a prospective randomized controlled study. Anesth Analg. 2019; 129: 235–40. DOI: 10.1213/ANE.0000000000004071
  29. Adhikary S.D., Bernard S., Lopez H., et al. Erector spinae plane block versus retrolaminar block: a magnetic resonance imaging and anatomical study. Reg Anesth Pain Med. 2018; 43: 756–62. DOI: 10.1097/AAP.0000000000000798
  30. Vilchis-Renteria J.S., Peng P.W.H., Forero M. The erector spinae plane block for obstetric analgesia: a case series of a novel technique. Anaesth Rep. 2020; 8: 170–3. DOI: 10.1002/anr3.12083
  31. de Haan J., Tabba S., Lee L., et al. Posterior quadratus lumborum block for labor analgesia: a case report. A A Pract. 2020; 14(7): e01193. DOI: 10.1213/XAA.0000000000001193
  32. Borglum J., Gogenur I., Bendtsen T.F. Abdominal wall blocks in adults. Curr Opin Anaesthesiol. 2016; 29(5): 638–43. DOI: 10.1097/ACO.0000000000000378
  33. La Colla L., Uskova A., Ben-David B. Single-shot quadratus lumborum block for postoperative analgesia after minimally invasive hip arthroplasty: a new alternative to continuous lumbar plexus block? Reg Anesth Pain Med. 2017; 42: 125–6. DOI: 10.1097/AAP.0000000000000523
  34. Blanco R., Ansari T., Riad W., et al. Quadratus lumborum block versus transversus abdominis plane block for postoperative pain after cesarean delivery: a randomized controlled trial. Reg Anesth Pain Med. 2016; 41(6): 757–62. DOI: 10.1097/AAP.0000000000000495
  35. Salama E.R. Ultrasound guided bilateral quadratus lumborum block vs. intrathecal morphine for postoperative analgesia after cesarean section: a randomised controlled trial. KoreanJ Anesthesiol. 2019. DOI: 10.4097/kja.d.18.00269
  36. Sebbag I., Qasem F., Dhir S. Ultrasound guided quadratus lumborum block for analgesia after cesarean delivery: case series. Rev Bras Anestesiol. 2017; 67(4): 418–21. DOI: 10.1016/j.bjan.2017.03.002
  37. Maenchen N., Hansen C.K., Dam M., et al. Ultrasound-guided transmuscular quadratus lumborum (TQL) block for pain management after caesarean section. Int J Anesth Anesthesiol. 2016; 3: 048. DOI: 10.23937/2377-4630/3/2/1048
  38. Nair A. Bilateral quadratus lumborum block for post-caesarean analgesia. IndianJ Anaesth. 2017; 61 (4): 362–63. DOI: 10.4103/ija.IJA_204_17
  39. Krohg A., Ullensvang K., Rosseland L.A., et al. The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery: a randomized clinical trial. Anesth Analg. 2018; 126(2): 559–65. DOI: 10.1213/ANE.0000000000002648
  40. Ishio J., Komasawa N., Kido H., et al. Evaluation of ultrasoundguided posterior quadratus lumborum block for postoperative analgesia after laparoscopic gynecologic surgery. J Clin Anesth. 2017; 41: 1–4. DOI: 10.1016/j.jclinane.2017.05.015
  41. Kadam V.R. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol. 2013; 29: 550–2. DOI: 10.4103/0970-9185.119148
  42. Visoiu M., Yakovleva N. Continuous postoperative analgesia via quadratus lumborum block — an alternative to transversus abdominis plane block. Paediatr Anaesth. 2013; 23: 959–61. DOI: 10.1111/pan.12240
  43. Ueshima H., Hiroshi O. Intermittent bilateral anterior subcostal quadratus lumborum block for effective analgesia in lower abdominal surgery. J Clin Anesth. 2017; 43: 65. DOI: 10.1016/j.jclinane.2017.09.018
  44. Chakraborty A., Goswami J., Patro V. Ultrasound-guided continuous quadrates lumborum block for postoperative analgesia in a pediatric patient. A A Case Rep. 2015; 4: 34–6. DOI: 10.1213/XAA.0000000000000090
  45. Chakraborty A., Khemka R., Datta T. Ultrasound-guided truncal blocks: a new frontier in regional anaesthesia. Indian J Anaesth. 2016; 60: 703–11. DOI: 10.4103/0019-5049.191665
  46. Sindwani G., Sahu S., Suri A., Saeed Z. Bilateral quadratus lumborum block for postoperative analgesia in a Von Hippel-Lindau syndrome patient undergoing laparoscopic radical nephrectomy. Saudi J Anaesth. 2017; 11: 513–4. DOI: 10.4103/sja.SJA_263_17
  47. Cardoso J.M., Sá M., Reis H., et al. Type II quadratus lumborum block for a subtotal gastrectomy in a septic patient. Rev Bras Anestesiol. 2016; 68(2): 186–9. DOI: 10.1016/j.bjan.2016.09.009
  48. Carvalho R., Segura E., Loureiro M.D., et al. Quadratus lumborum block in chronic pain after abdominal hernia repair: case report. Braz J Anesthesiol. 2017; 67: 107–9. DOI: 10.1016/j.bjane.2014.08.010
  49. 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): 674–9. DOI: 10.1097/AAP.0000000000000645
  50. Watanabe K., Mitsuda S., Tokumine J., et al. Quadratus lumborum block for femoral-femoral bypass graft placement: a case report. Medicine (Baltimore). 2016; 95(35): e4437. DOI: 10.1097/MD.0000000000004437
  51. Ueshima H., Hiroshi O. Lumbar vertebra surgery performed with a bilateral posterior quadratus lumborum block. J Clin Anesth. 2017; 41: 61. DOI: 10.1016/j.jclinane.2017.06.012
  52. Iwamitsu R., Ueshima H., Otake H. Intermittent bilateral posterior quadratus lumborum block was effective for pain management in lumbar spinal fusion. J Clin Anesth. 2017; 42: 16. DOI: 10.1016/j.jclinane.2017.08.012
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