Quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeries: A 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.

Perioperative Analgesic Efficiency of Ultrasound-Guided Quadratus Lumborum Block versus Epidural Analgesia in Bladder Cancer Patients Undergoing Radical Cystectomy

“…The previous studies have demonstrated the effectiveness of QLB in different types of abdominal operations, including cesarean section [25], [26], laparoscopic gynecological surgery [27], total abdominal hysterectomy [28], and other abdominal surgeries [29], [30]. A meta-analysis showed that QLB provides better pain management with less opioid consumption after abdominal surgery compared with TAP block [31]. Transmuscular QLB was associated with reduced postoperative sufentanil consumption hours and nausea and vomiting compared to the control group in patients undergoing laparoscopic nephrectomy [32].…”

Comparison of the postoperative analgesic effect of transversus abdominis plan block and quadratus lumborum block: A prospective randomized study

“…Liu et al 15 compared TAP and QL blocks in terms of pain management in patients undergoing abdominal surgery. Statistically significant differences were observed between the two groups in postoperative pain scores at 2, 4, 6, 12, and 24 h. Morphine consumption at 24 h was lower in patients undergoing QL, and postoperative analgesia time was longer.…”

“…Although local anesthetic systemic toxicity related to QL and TAP block has not been reported in the literature, we preferred a smaller volume of 20 ml because the local anesthetic concentration detected in plasma in TAP block was observed to be higher than in QL block. 14 Liu et al 15 compared TAP and QL blocks in terms of pain management in patients undergoing abdominal surgery. Statistically significant differences were observed between the two groups in postoperative pain scores at 2, 4, 6, 12, and 24 h. Morphine consumption at 24 h was lower in patients undergoing QL, and postoperative analgesia time was longer.…”

Randomized controlled trial of a quadratus lumborum block with liposomal bupivacaine for postoperative analgesia in laparoscopic donor nephrectomy

“…For patients undergoing abdominal or inguinal surgeries, QL block alone may even be superior to TAP block. 17,18 In our practice an incisional TAP block with bupivacaine was incorporated into the ERAS protocol for donor nephrectomy partly because it can be easily and quickly administered by the surgeon under direct vision with the laparoscope and therefore does not add a significant amount of time to the procedure. We chose liposomal bupivacaine with the goal of prolonging duration of the effect compared to plain bupivacaine.…”