A Comparative Study of Ultrasound-Guided Quadratus Lumborum Block and Transversus Abdominis Plane Block for Postoperative Analgesia Following Total Abdominal Hysterectomy

Abstract

Background: Total abdominal hysterectomy (TAH) results in remarkable postoperative pain. Truncal nerve blocks like the quadratus lumborum (QL) block and transversus abdominis plane (TAP) block are described to combat this pain. The aim of the present study was to compare the effectiveness of the QL block with the TAP block in terms of numeric rating scale (NRS) scores as the primary outcome for postoperative pain in TAH. The secondary outcome was time of the first analgesic demand, total analgesic demands required in 24 hr, and patient satisfaction level.Methods: Seventy patients of American Society of Anesthesiologists (ASA) physical status class I and II, aged 35-65 years with a body mass index (BMI) 18-30 kg/m 2 planned for elective TAH under spinal anaesthesia were randomly allocated into two groups. Group Q received QL block and Group T received TAP block under ultrasound guidance with 40 ml of 0.25% bupivacaine of which 20 ml was injected on either side.Results: Demographic data of both groups was comparable. The NRS pain score was significantly lower in Group Q compared to Group T at the fourth and sixth hour. The mean first analgesic demand was significantly early in Group T compared to Group Q (5.69 ± 0.87 hr vs. 11.23 ± 2.22 hr) and total analgesic demands were significantly greater in Group T than Group Q. The mean patient satisfaction score was significantly high in Group Q compared to Group T (5.8 ± 0.41 vs. 4.74 ± 0.44). Conclusion:The combined posterior and anterior approach of the QL block may represent a more efficacious alternative to the TAP block in patients after TAH. Further studies are recommended to evaluate the ideal dose, volume and approach for the QL block.

Quadratus lumborum block versus transversus abdominis plane block for inguinal hernia repair: A systematic review and meta‐analysis with trial sequential analysis

“…In contexts like total abdominal hysterectomy, laparoscopic colorectal surgery, and cesarean sections, the QLB has consistently outperformed in areas such as opioid consumption, duration of analgesia, and patient satisfaction. [52][53][54] Given that these surgical procedures can involve more extensive manipulation of abdominal viscera, the ability of QLB to induce both parietal and visceral analgesia can be a great advantage. Such dual analgesia is theorized to be due to the spread of local anesthetic into the paravertebral space.…”

New Kid on the Block: A Systematic Review of the Quadratus Lumborum Block in Plastic and Reconstructive Surgery

“…[7][8][9][10][11][12][13][14][15][16][17][18] The QL block has been hypothesized as an effective alternative to the TAP block in abdominalbased breast reconstruction, with some studies finding improved pain control with the QL block. 19,20 Yet, no consensus has been reached regarding the superiority of either block. 21,22 The TAP block involves injection of local anesthetic between the transversus abdominus and internal oblique muscles to target the intercostal, subcostal, iliohypogastric, and ilioinguinal nerves.…”

“…7–18 The QL block has been hypothesized as an effective alternative to the TAP block in abdominal-based breast reconstruction, with some studies finding improved pain control with the QL block. 19,20 Yet, no consensus has been reached regarding the superiority of either block. 21,22…”