Efficacy of a TAP block versus an anterior QLB for laparoscopic inguinal hernia repair: A randomised controlled trial

Abstract

Background: Both the transversus abdominis plane (TAP) block and the anterior quadratus lumborum block (QLB) have been shown effective in reducing postoperative pain after laparoscopic inguinal hernia repair. Our hypothesis was that there is no difference in analgesic effect between the two blocks for this procedure.Methods: In this prospective, double-blind, randomised controlled study, 60 adult patients undergoing laparoscopic inguinal hernia repair were equally randomly assigned to either a preoperative TAP block or an anterior QLB. The primary outcome was oral morphine equivalent (OME) consumption at 4 h postoperatively. Secondary outcomes were OME consumption at 24, 48 h and 7 days, pain scores at rest and when coughing, nausea, and level of sedation measured at 1, 2, 3, 24, and 48 h and 7 days postoperatively.Results: Fifty-three patients completed the study. There was no significant difference in OME consumption at 4 h postoperatively, TAP group (10.3 ± 7.85 mg) (mean ± SD) versus the anterior QLB group (10.9 ± 10.85 mg) (p = .713). The pain scores were similar at rest and when coughing during the 7 day observation period, as were the level of sedation and incidence of nausea. There were no cases of serious side-effects or muscle weakness of the thigh on the same side as the block. Conclusion:There is no difference in OME consumption, pain, nausea or sedation between the TAP and the anterior QLB. Thus, the choice between the two blocks in a clinical setting of laparoscopic inguinal hernia repair should be based on other aspects, such as skills, practicalities, and potential risks.

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

“…We included five RCTs comprising a sample of 255 patients. [33][34][35][36][37] Our results indicate that QLB may offer superior postoperative pain reduction in patients undergoing inguinal hernia repair.…”

“…For instance, while Sorenstua et al found no difference in opioid use between the two groups, Roy et al observed a 25% reduction in fentanyl use in the QLB group at the 24-h postoperative mark. 36,37 Consequently, future research focusing on postoperative opioid consumption in patients undergoing inguinal hernia repair should ensure sufficient power to discern true effects.…”

“…Opioid consumption in 24 h was reported in three studies. 33,36,37 There was no significant difference in opioid consumption between QLB and TAPB groups (MD −7.81 mg; 95% CI −18.69 to 3.06 mg; p = 0.16; and I 2 = 82%; Figure 2A). After sensitivity analysis, the results remained consistent and unchanged.…”

“…Five RCTs were included, [33][34][35][36][37] comprising 255 patients: 128 in the QLB group and 127 in the TAPB group. The search process is summarized in Figure 1.…”

“…[33][34][35]37 Three studies reported pain in the visual analogue scale (VAS) score [33][34][35] and one study in the numerical rating scale (NRS) score. 37 In the overall analysis, postoperative pain was significantly lower in the QLB group when compared to the TAPB group (MD −0.45; 95% CI −0.75 to −0.14; p = 0.004; and I 2 = 94%; Figure 1). After sensitivity analysis, the results remained consistent and unchanged.…”