REPAIR-CS: A Three-Arm Randomized Trial

Background: Optimizing postoperative pain management after cesarean delivery is essential for early maternal recovery. Regional nerve blocks using long-acting local anesthetics may offer a promising approach. However, high-quality clinical evidence supporting their efficacy in this setting remains limited. <div> <br> </div> <div> Methods: We evaluated the effect of single-shot bilateral quadratus lumborum block with liposomal bupivacaine on postoperative pain and the quality of early recovery in a randomized clinical trial of patients undergoing cesarean delivery. Participants were randomly assigned to receive postoperative analgesia with a bilateral quadratus lumborum block using liposomal bupivacaine (LB group), a bilateral quadratus lumborum block with ropivacaine combined with patient-controlled intravenous analgesia (R-P group), or patient-controlled intravenous analgesia alone (P group). The primary outcome was postoperative pain intensity during turning over within the first 72 h after cesarean delivery, assessed using the visual analog scale. Secondary outcomes included pain intensity at rest, quality of recovery, postoperative nausea and vomiting, maternal satisfaction, postoperative acute analgesic requests, sleep quality, anxiety, maximum walking duration, postoperative opioid consumption, and length of hospital stay. </div> <div> <br> </div> <div> Findings:&nbsp; A total of 196 women (mean [standard deviation] age, 32.3 [4.4] years) were included in the modified intention-to-treat analysis, with 67 assigned to the P, 65 to the R-P, and 64 to the LB group. The baseline characteristics were comparable across the groups. Compared with P and R-P groups, the LB group demonstrated significantly lower overall movement-evoked pain across the first three postoperative days, with median differences of –1.39 [95% confidence interval (CI), –1.57 to –1.20; P &lt; .001] and −0.90 [95% CI, –1.09 to –0.71; P &lt; .001], respectively. The overall movement-evoked pain scores in the R-P group were also significantly lower than those in the P group (median difference, –0.49 [95% CI, –0.64 to –0.33]; P &lt; .001). </div> <div> <br> </div> <div> Interpretation: Bilateral quadratus lumborum block with liposomal bupivacaine improved postoperative movement-evoked pain after cesarean delivery and was associated with better early recovery, reduced postoperative nausea and vomiting, shorter hospitalization, and higher patient satisfaction, consistent with enhanced recovery after surgery (ERAS) principles in parturients. </div>