Ultrasound-Guided Bilateral Transverses Abdominis Plane Block Versus Bilateral Quadratus Lumborum Block on Postoperative Analgesia in Women Undergoing Total Laparoscopic Hysterectomy

Background: No trials compared two methods of bilateral quadratus lumborum (QL) block and transverses abdominis plane (TAP) block in patients undergoing laparoscopic hysterectomy. Hence the present study compared the ultrasound-guided bilateral TAP and QL blocks and measured the pain score, rescue anesthesia requirement, adverse events, and patient satisfaction. Materials and Methods: This prospective randomized, open-labeled study was conducted on ۱۴۰ adult female patients (ASA I-II) scheduled for total laparoscopic hysterectomy. Patients were randomized into two equal groups of ۷۰ each (group TAP and group QL). Each patient received an Ultrasound-guided bilateral TAP or QL block after completion of laparoscopic hysterectomy under general anesthesia. Patients were monitored for visual analog scale (VAS) scores postoperatively, time for first analgesic requirement, and any adverse effects. Independent t-test and Chi-square test were used for statistical analysis. Results: The QL group showed significantly better VAS scores up to ۲۴ hr postoperatively. VAS scores were significantly higher in the TAP group than in the QL group at all intervals postoperatively (P<۰.۰۵). The duration of postoperative analgesia was significantly shorter in the TAP group (P<۰.۰۵), and the total analgesic requirement was lesser in the QL group (P<۰.۰۵). The first request for rescue analgesia was significantly longer in the QL group (۴۹۷.۷۷۴±۳۵.۴۵ vs. ۲۴۷.۵۵±۱۱.۷۱min, P<۰.۰۰۱), and its consumption was significantly lesser in the QL group (۷۲.۱۴۲۸±۱۸.۳۲۸ vs. ۱۳۸.۵۷±۲۵.۷۷mg). The time for the first analgesic demand (Tramadol) was prolonged in the QL group (۱۵.۱± ۲.۱۲ vs. ۴.۳۵ ±۵ hours). The sensory level was higher in the QL group, with a significant difference (۷.۹۲±۰.۵۱ vs. ۵.۹۷±۰.۳۵, P<۰.۰۰۱). Three patients (۴.۲۸%) in the QL group experienced vomiting versus ۶ (۸.۵۷%) in the TAP group. Patient satisfaction score was comparable between groups (۴.۷۸ ± ۰.۴۵ vs. ۴.۲۲ ± ۰.۴۲). Conclusion: Bilateral QL block provided a better postoperative analgesia technique in women undergoing laparoscopic hysterectomy.

کلیدواژه ها:

Postoperative analgesia ، Quadratus lumborum ، Transverses abdominis ، Laparoscopic hysterectomy ، Visual analog score