Comparative Effectiveness of ESP and QL Block On IL-6 Response and Postoperative Pain in Cesarean Delivery
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Abstract
Introduction: Postoperative pain after cesarean section can trigger stress responses and systemic inflammation, characterized by increased proinflammatory cytokines such as IL-6. Effective regional analgesia is essential not only for pain control but also for attenuating postoperative inflammatory responses. QLB and ESP block are widely used regional analgesia techniques; however, comparative evidence regarding their effects on inflammatory markers and clinical analgesic outcomes remains limited.
Objectives: This study aimed to compare the effectiveness of the quadratus lumborum block (QLB) and erector spinae plane (ESP) block in reducing postoperative inflammatory response, as measured by interleukin-6 (IL-6), and improving postoperative analgesic outcomes in patients undergoing cesarean section.
Methods: This randomized controlled trial with a comparative design included 48 patients undergoing cesarean section, randomly assigned to either the QLB group (n = 24) or the ESP group (n = 24). Serum IL-6 levels were measured 2 hours preoperatively and 6 hours postoperatively. Analgesic outcomes were assessed using Visual Analog Scale (VAS) scores at 0 minutes, 30 minutes, 6 hours, 12 hours, and 24 hours after surgery. Additional outcomes included time to first rescue analgesia (FRA), frequency of rescue analgesia (RA) within 24 hours, and patient satisfaction evaluated using the Patient Satisfaction Score.
Results: Postoperative IL-6 levels at 6 hours were significantly lower in the QLB group compared with the ESP group (p < 0.05). The QLB group also demonstrated significantly lower VAS scores in the early postoperative period, longer time to FRA (p < 0.001), reduced RA frequency (p = 0.002), and higher patient satisfaction (p < 0.05).
Conclusions: Quadratus lumborum block is more effective than erector spinae plane block in reducing postoperative inflammatory response and improving analgesic outcomes following cesarean section.