Bilateral ultrasound-guided quadratus lumborum block versus intravenous patient-controlled-analgesia ketamine for total abdominal laparoscopic hysterectomy

Abstract

Background Total abdominal laparoscopic hysterectomy patients experience pain in various degrees mediated via the thoracic sympathetic trunk as well as parasympathetic afferent nerves. The bilateral quadratus lumborum block (QLB) was believed to provide somatic as well as visceral pain relief however the use of anesthetic agents is associated with increased side effects. IV-Patient-controlled analgesia ketamine is suggested to play an effective role in acute pain management. Also, it increases patient satisfaction with decreased side effects as it reduces the levels of the consumed opioids. Patient and methods This prospective study was done in Mansoura University hospitals from December 2022 to May 2023. The study was conducted on 100 patients. Our study included patients who were categorized into two groups. All patients underwent total abdominal laparoscopic hysterectomy with the first group underwent ultrasound-guided bilateral QLB and the second group administered IV ketamine via Patient-controlled analgesia for pain management. Results At 30 min postoperative there was no significant difference between the two groups regarding visual analog scale score. Visual analog scale score was significantly higher in group I after 1 h postoperative and until 36 h. Postoperative Morphine consumption was significantly lower in group I. Pruritis was significantly higher in group I. Bradycardia and hypotension were significantly higher in group II. Conclusion Bilateral QLB was more potent than intravenous ketamine.