QLB vs Intrathecal Morphine: Pain, Recovery & 3 Randomized Trials

Can quadratus lumborum block replace intrathecal morphine, or add useful analgesia? This short clinical lecture reviews three randomized trials, following Background - Methods - Results - Discussion for each paper. Original animated study diagrams, pain charts, recovery scores and noninferiority confidence intervals make the comparisons easier to follow. Key findings: Uppal: Six-hour resting NRS means were 4.3 with ITM, 1.4 with lateral QLB and 1.0 with both. The reported 24-hour QoR-40 90% CI (-0.9 to 13.5) crossed the 10-point noninferiority boundary. Recovery-domain scores were not reported. Giral: The primary text reports 24-hour IV morphine means of 13.7 vs 11.1 mg (QLB vs ITM; P=.111). Posterior QLB had a higher 24-hour ObsQoR-11 mean (84.7 vs 75.6) and less itching (1/50 vs 18/51). Recovery and itching were secondary outcomes. Morphine totals differ between the primary text and cumulative-dose table. Kaya: For laparoscopic nephrectomy, 24-hour IV MME medians were 15 vs 6 mg (QLB vs spinal regimen). The reported ITT location-shift estimate was +9.5 mg (95% CI 7 to 12), exceeding the +5.27 mg margin. The comparator included ITM plus spinal bupivacaine.