Comparison of erector spinae plane block versus quadratus lumborum block for post-caesarean analgesia: Systematic review, meta-analysis, and trial sequential analysis

Background and Aims: Post-caesarean pain significantly impacts maternal recovery. The erector spinae plane (ESP) and quadratus lumborum block (QLB) are regional analgesic techniques used for postoperative pain management; however, their comparative effectiveness remains uncertain. The objective was to compare the efficacy of ESP and QLB regarding post-caesarean pain intensity, opioid consumption, time to first analgesic request, and the incidence of nausea and vomiting. Methods: A systematic review and meta-analysis of randomised controlled trials comparing ESP and QLB in women undergoing caesarean section was conducted according to PRISMA guidelines (PROSPERO ID: CRD42024612438). The electronic databases PubMed, Embase, Cochrane Library, and Scopus were searched. Effect sizes were estimated using a random-effects model, and trial sequential analysis (TSA) was performed to assess the robustness of the evidence. Results: Six studies involving a total of 466 patients were included. No significant differences were observed between ESP and QLB in postoperative pain scores measured by the Numeric Rating Scale at 12 hours [mean difference (MD): 0.10; 95% confidence interval (CI): -0.14, 0.35; P = 0.40] and 24 hours (MD: −0.34; 95% CI: -0.74, 0.07; P = 0.10). The time to the first analgesic request was significantly longer in the QLB group (MD: 1.40 hours; 95% CI: 0.42, 2.38; P = 0.005). Opioid consumption within the first 24 hours was comparable between the two techniques ( P = 0.93), as was the incidence of nausea and vomiting ( P = 0.50). TSA did not confirm firm evidence for differences in opioid consumption, pain intensity at 24 hours, or time to first rescue analgesia, and the results remained inconclusive. Conclusion: ESP and QLB provide comparable analgesia, though current evidence remains inconclusive. Larger multicentre trials are warranted to confirm these findings.