Quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeriesA systematic review and meta-analysis of randomized controlled trials

Abstract

Background Abdominal surgery is common and associated with severe postoperative pain. Transverse abdominal plane (TAP) block is considered an effective means for pain control in such cases. Quadratus lumborum (QL) block is another option for the management of postoperative pain. The aim of this study was to conduct a meta-analysis and thereby evaluate the efficacy and safety of QL block and TAP block for pain management after abdominal surgery. Methods We comprehensively searched PubMed, Embase, EBSCO, the Cochrane Library, Web of Science and CNKI for randomized controlled trials (RCTs) that compared QL block and TAP block for pain management in patients undergoing abdominal surgery. All of the data were screened and evaluated by two researchers. RevMan5.3 was applied to perform the meta-analysis. Results A total of 8 RCTs involving564 patients were included. The meta-analysis showed statistically significant differences between the two groups with respect to postoperative pain scores at 2 hours (standardized mean difference [Std.MD]=-1.76; 95% confidence interval [CI]=-2.63 to -0.89; p<.001), 4 hours (Std.MD=-0.77; 95% CI=-1.36 to -0.18; p=.01),6 hours (Std.MD=-1.24; 95% CI=-2.31 to -0.17; p=.02),12 hours (Std.MD=-0.70; 95% CI=-1.27 to -0.13; p=.02) and 24hours (Std.MD=-0.65; 95% CI=-1.29 to -0.02; p=.04) ; postoperative opioid consumption at 24 h (Std.MD=-1.39; 95% CI=-1.83 to -0.95; p<.001); and duration of postoperative analgesia (Std.MD=2.30; 95% CI=1.85 to 2.75; p<.001). There was no statistically significant difference between the two groups regarding postoperative nausea and vomiting (PONV) incidence (RR=0.55; 95% CI=0.27 to 1.14; p=.11). Conclusion QL block provides better pain management with less opioid consumption than TAP block after abdominal surgery. In addition, there are no differences between TAP block and QL block with respect to PONV.