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Abstract To explore the effects of the ultrasound-guided supra-arcuate ligament quadratus lumborum block (SA-QLB) for women with the second caesarean section on their postoperative analgesia and recovery quality. Methods: 60 pregnant women who wanted the second cesarean section were selected and were randomly divided into observation group (n=30) and control group (n=30) from December 2022 to March 2024. The women in the observation group were given SA-QLB during cesarean section, and the women in the control group were given the posterior quadratus lumborum block (P-QLB). The visual analogue scale (VAS) scores of the incision pain and the uterine contraction pain at different time points, the block segment, the postoperative analgesic effect, the postoperative recovery indicators values, the block operation time, and the rates of adverse reactions and block-related complications of the women were compared between the two groups. Results: The VAS score ［M (P25, P75)］ of the uterine contraction pain of the women in the observation group at 6h, 12h, and 24 after the anesthesia block were 2.0 (1.0,2.0) points, 3.0 (2.0,3.0) points and 2.0 (2.0,3.0) points, respectively, and which were significantly lower than those ［3.0 (2.0,3.0) points, 3.0 (3.0,5.0) points and 3.0 (3.0,4.0) points, respectively］ of the women in the control group. The number of the block segments of the women in the observation group at 6 h, 12h, 24h, and 48h after anesthesia block were 8.0 (8.0, 9.0), 8.0 (7.0,8.0), 7.0 (6.0,7.0) and 2.0 (2.0,3.0), respectively, and which were significantly more than those ［5.0 (5.0,6.0), 3.0 (3.0,4.0), 2.0 (1.0,2.0) and 0, respectively］ of the women in the control group. The consumption dosage of sufentanil ［48.0 (48.0,48.0) ug］ of the women in the observation control group in 48h after operation was significantly less than that ［48.0 (48.0,52.0) ug］ of the women in the control group. The incidence of the moderate and severe uterine contraction pain (6.7%) of the women in the observation group was significantly lower than that (30.0%) of the women in the control group. The ObsQoR-11 score (96.7±7.0 points) of the women in the observation group at 24h after operation was significantly higher than that (92.6±7.3 points) of the women in the control group, and the block operation time (8.07, 0-9.0 min) of the women in the observation group was significantly longer than that (5.0, 4.0-6.0 min) of the women in the control group (all P<0.05). There were no significant differences in the VAS score of the incision pain at different time points, the incidence of the moderate or severe pain of the incision, the rate of the postoperative analgesia again, the analgesic satisfaction, the first exhaust time, the first time of getting out of the bed, the incidence of nausea and vomiting of the women between the two groups (all P>0.05). There were no other adverse reactions and block-related complications of the women in the two groups. Conclusion: Compared with those of P-QLB, the block plane of SA-QLB for the women with the second caesarean section is much wider, and which can effectively alleviate the postoperative uterine contraction pain and improve the early recovery quality of these women. However, the block operation time of SA-QLB is longer and the placement of the block position is more difficult, and so its advantages of the women with the second caesarean section still need further research and verification.
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