Transmuscular quadratus lumborum block versus oblique subcostal transversus abdominis plane block for analgesia in laparoscopic hysterectomy: a randomised single-blind trial

Abstract

ObjectiveThe transmuscular quadratus lumborum (TQL) block and the oblique subcostal transversus abdominis plane (OSTAP) block both contribute to multimodal analgesia after laparoscopic surgery. The objective of this study was to compare the analgesic effects of the TQL block versus OSTAP block after laparoscopic hysterectomy.DesignProspective single-centre randomised single-blind trial.SettingUniversity-affiliated hospital.ParticipantsPatients aged between 18 and 65 years scheduled for laparoscopic hysterectomy.InterventionsPatients were randomised into two groups (1:1 ratio) and received bilateral TQL block or bilateral OSTAP block with 0.375% ropivacaine 20 mL on each side before surgery.Primary and secondary outcome measuresThe primary outcome measure was the cumulative morphine dose in the first 24 hours. The secondary outcome measures were the morphine consumption at each time interval after surgery, the time from the end of surgery to the first need for morphine, the Numerical Rating Scale (NRS) scores for visceral and incisional pain intensity, and the incidence of adverse events.ResultsThe cumulative morphine dose was significantly lower in the TQL group than in the OSTAP group (17.2 (12.5) vs 26.1 (13.3) mg, p=0.010). Compared with the OSTAP group, the morphine doses from 6 to 12, 12 to 18, and 18 to 24 hours were significantly lower, the time of first need for morphine was significantly longer and the NRS scores for visceral pain intensity were significantly lower in the TQL group.ConclusionCompared with the OSTAP block, the TQL block reduced morphine consumption and provided better visceral pain relief with a longer duration of effect after laparoscopic hysterectomy.Trial registration numberChinese Clinical Trial Registry (ChiCTR1800017995); pre-results.

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

“…They found that the VAS score was lower in the QL block group at 2, 4, 6, 8, 12, 18, and 24 hr than the control group. Huang et al compared the transmuscular QL block and oblique subcostal TAP block for analgesia after hysterectomy [ 13 ]. They found that NRS scores for visceral pain intensity were significantly lower in the QL group than TAP group.…”

A Dose-Response Relationship Study of Prophylactic Nalbuphine to Reduce Pain During the Awakening Period in Patients Undergoing Laparoscopic Total Hysterectomy: A Randomized, Controlled, Double-Blind Clinical Study

“…Some researchers have found that local anesthetics injected at the trocar site, or a nerve block performed before surgery can reduce postoperative pain in patients undergoing laparoscopic surgery. 30 , 31 If prophylactic nalbuphine is used in combination with these methods, better analgesia may be achieved. This study only focused on patients undergoing laparoscopic surgery, whereas total hysterectomy includes transabdominal, transvaginal, and laparoscopic-assisted surgery, and the surgical incision and postoperative pain caused by different methods vary.…”

Interfascial Plane Blocks in Obstetric and Gynecologic Surgery

“…31,32 QLB significantly reduces perioperative opioid use after CD, 8,[22][23][24][26][27][28]33 laparoscopic hysterectomy (LH), [34][35][36] and total abdominal hysterectomy (TAH), 37,38 and consequently a frequency of postoperative nausea and vomiting. 35 QLB as a part of multimodal pain management, given in combination with paracetamol and NSAID, also prolongs time to first request for breakthrough pain following CD, 8,[22][23][24]27,33 LH, 34,35,39 and TAH. 38 QLB provides larger filed of analgesia and more lasting analgesia (up to 24-36 hours) compering to TAP block (up to 10 hours) after CD, 23,27,28,33 LH 34,39 and TAH, 37,38 decreasing a number of breakthrough pain requests.…”

“…( 35 ) QLB as a part of multimodal pain management, given in combination with paracetamol and NSAID, also prolongs time to first request for breakthrough pain following CD, ( 8 , 22 - 24 , 27 , 33 ) LH, ( 34 , 35 , 39 ) and TAH. ( 38 ) QLB provides larger filed of analgesia and more lasting analgesia (up to 24-36 hours) compering to TAP block (up to 10 hours) after CD, ( 23 , 27 , 28 , 33 ) LH ( 34 , 39 , 40 ) and TAH, ( 37 , 38 ) decreasing a number of breakthrough pain requests. Having a skin injection point more lateral of surgical incision than TAP block, QLB minimizes a risk for surgical site contamination.…”