Cesarean section commonly induces moderate to severe pain for 48 hours. These patients have
additional compelling reasons to provide adequate pain relief as early mobilization is a key
factor to prevent the risk of thromboembolic event which is increased during pregnancy.
Beside these, patients need to be pain free to takecare for their newborn and breastfeed
them. Poorly controlled pain after cesarean section also increases risk of chronic pain and
postpartum depression.

Intrathecal morphine is considered the "gold standard" for postoperative pain relief after
cesarean delivery. The duration of analgesic effect of morphine extend to 12-24 hours. Its
widespread use is due to its favorable pharmacokinetic profile, ease of administration and
low cost. Although intrathecal morphine is highly effective, its use is associated with
undesirable adverse effect particularly nausea, vomiting and pruritus which reduce overall
patients’ satisfaction. More serious complication is the risk of delayed maternal respiratory
depression.

The Quadratus Lumborum block was first described in 2007 which demonstrates a spread to the
paravertebral space, thus leads to a more extensive block to T5-L1 nerve branches and a long
lasting block with the potential to provide visceral pain relief. Therefore, this block has
an evolving role in postoperative analgesia for many lower abdominal surgeries. As the safety
is concerned, there has been one report of a patient with unilateral hip flexion and knee
extension weakness leading to unplanned overnight admission following lateral quadratus
lumborum block after laparoscopic gynaecological operation.

If the result favors effective, it will have the advantage of a combination with intrathecal
opioid to prolong the pain free period after cesarean section which has about 4,000 cases per
year.