Lateral Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Laparoscopic Surgery: A Randomized Controlled Study

Abstract

Background. After laparoscopic abdominal surgery, we aim to evaluate the analgesic efficiency of US-directed bilateral transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB). Methods. 50 patients aged 18–60 years listed for elective laparoscopic abdomen operation were registered in this study. Cases were randomly allocated into two similar groups: TAPB and QLB groups. The first outcome was the growing morphine consumption on the 1st day postoperatively. The second outcome involved VAS score, first analgesic necessities, and any postoperative complications. Statistical analysis was done with the 2-sample t-test, and Mann–Whitney U testing was utilized to compare medians for skewed end points. Qualitative data were introduced as numbers and percentages, and chi-squared testing was utilized to determine the significance. Results. The median cumulative morphine consumptions on the 1st day were high significantly in the TAPB group than in the QLB group (6 mg [6, 9] vs. 3 mg [3, 6], p value ≤ 0.0001 ]). The QLB group showed an increase in the median of the time to the first analgesic request in comparison with the TAPB group (17 hours [12, 24] vs. 8 hours [6, 24], p ≤ 0.001 ). In addition, on the 1st day, the mean VAS scoring at rest was lower in the QLB group. Conclusion. In comparison to the TAPB, the QL block delivers more successful pain relief, has an extended period of analgesic actions, extends interval to the 1st analgesic necessity, is accompanied with lesser morphine consumptions, and may be utilized in multimodal analgesia and opioid-sparing regimens after that laparoscopic operation. This trial is registered with NCT04553991.

Ultrasound guided erector spinae plane block versus quadratus lumborum block for post-operation analgesia in laparoscopic cholecystectomy surgeries: A randomized controlled trial

“…Total morphia dosage in 1st 1 day postoperation was significantly less in ESPB and QLBs versus groups C (P value<0.001) and was similar between groups ESPB and QLB. Similar to our findings, Fargaly et al, [23] documented that the median morphine dosage was significantly less in QLB versus TAPB group. In agreement with our findings, Huang and 1 day after surgery, cases underwent US ESPB required significantly less IV opioids (standardized mean difference [SMD] = -2.18; 95% CI -2.76 to -1.61, p< 0.00001).…”

“…Hematoma didn't occur in any case in the three groups. In the same context, Fargaly et al, [23] reported that Both techniques QLB showed nonsignificant Also, Abd Ellatif and Abdelnaby [19] reported that no block-related or local anesthetic-toxicity-related complications were observed among the intervention groups (QLB and ESPB).…”

Transversus Abdominis Plane Block as a Strategy for Effective Pain Management in Patients with Pain during Laparoscopic Cholecystectomy: A Systematic Review

“…US-TAP Subcostal block is associated with less pain experience and opioid consumption compared with quadratus lumborum [ 78 ]. Between 0 and 6 h postop, the US-TAP subcostal block appeared to be associated with higher pain perception; in contrast, the quadratus lumborum was perceived as more painful between 12 and 24 h [ 97 ]. To view it differently, quadratus lumborum reportedly had lower pain perception, lower cumulative daily Morphine consumption, and longer median time to first analgesic request compared with US-TAP block [ 97 ].…”

“…Between 0 and 6 h postop, the US-TAP subcostal block appeared to be associated with higher pain perception; in contrast, the quadratus lumborum was perceived as more painful between 12 and 24 h [ 97 ]. To view it differently, quadratus lumborum reportedly had lower pain perception, lower cumulative daily Morphine consumption, and longer median time to first analgesic request compared with US-TAP block [ 97 ]. Therefore, further quantification is needed to clarify the pattern of analgesic consumption during different TAP blockade procedures.…”

“…The analgesic request was found to be higher among those receiving the US-TAP block (18, 72%) as compared to the quadratus lumborum block (14, 56%). Cumulative daily Morphine consumption was significantly higher in the US-TAP block group (6 mg (6–9)) than in the quadratus lumborum block group (3 mg (3–6)), p = 0.001 [ 97 ]. The median time to first analgesic request was longer in the quadratus lumborum block group (17 h (12, 24)) than in the US-TAP block group (8 h (6, 24)), p ≤0.001 [ 97 ].…”